Sutter Health

Role Description The position is responsible for advancing the mission of the Ethics and Compliance Services (ECS) in a manner consistent with the values and standards of the compliance profession. Functions as a subject matter expert and hospital facility coding compliance leader through the accurate development, review, and approval of system processes, directives, and tools regarding regulatory reporting and coding compliance with revenue cycle operations. - Fosters strategic relationships within Sutter Health to maintain a culture of compliance. - Provides accurate hospital facility coding compliance guidance. - Develops and delivers educational communications. - Participates in the department's annual risk assessment and work plan development processes. - Assists in investigations to provide subject matter expertise knowledge during an investigation. - Participates in improving the delivery of Ethics and Compliance Services consultative, education, training, and compliance with regulatory, system, department, and professional standards. - Provides input into the enhancement of hospital facility coding, billing, and reporting workflows and tools for the health system. Qualifications - Bachelor Degree (Equivalent experience will be accepted in lieu of the required degree or diploma). - CCS-Certified Coding Specialist. - 5 years recent relevant experience. Requirements - Ability to design and implement regulatory and specialty specific education/training to a wide variety of professionals. - High level of expertise in the application of skills related to coding, billing, and reporting compliance. - Thorough understanding of rules/regulations/guidelines/policies/protocols related to mandatory reporting requirements to OSHPD. - Deep understanding of ICD-10-CM/PCS. - Well-developed written, verbal, and interpersonal communication skills. - Experience performing coding/billing investigations, audits, or reviews. - Computer skills, including business, coding, spreadsheet, presentation, word processing, and analytical support applications. Benefits - Comprehensive benefits package.

Role Description Delivers transitions of care services through coordination of medication reconciliation, medication access and coverage, and post-discharge calls while delivering patient education across care settings to ensure safe, accurate, and timely medication use at discharge. This role collaborates with providers and care teams to reduce medication-related errors, prevent readmissions, and support continuity of care. - Delivers pharmaceutical care through the provision of patient-centered clinical service, medication information, education, medication preparation and distribution that ensures safe, effective, and cost-efficient medication therapy. - Exercises sound judgment and developed clinical skills to provide input to and implement the patient's plan of care based on the diagnosis in a timely manner. - Gains confidence and cooperation from the patient, their family/support group, and other healthcare providers through competent patient assessment, attentive monitoring and care, and effective communication. - Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care. - May also be responsible for performing specific tasks and/or orienting other staff to the department. Qualifications - PHARMD - Graduate of an accredited pharmacy school - RPH - Registered Pharmacist within 120 days - ACLS - Advanced Cardiac Life Support if required by the entity/department - PALS - Pediatric Life Support if required by the entity/department Requirements - 1 year of recent relevant experience. - Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations. - Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures. - Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications. - Requires a basic working knowledge of legal requirements and accreditation standards including NABP, TJC, Title XXII, DHS, DEA, FDA, and USP. - Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. - Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized operating procedures and scientific methods to achieve objectives and meet deadlines. - General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, EHR, and EPIC. - Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions. - Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options. - Ensure the privacy of each patient’s PHI. Benefits - Eligible positions include a comprehensive benefits package.

• Responsible for completion of credentialing functions • Ensures program integrity and compliance with standards, federal/state requirements, and health plan credentialing requirements • Maintains relationships with health plan auditors, communicates and works with physician leaders on credentialing issues • Works with other departments in multiple areas that relate to credentialing issues • Audits Credentialing Verification Organization's released files to ensure it obtains primary source verification of required physician information • Maintains database of current and accurate information concerning licensure, board certification, professional liability coverage and claims for physicians, contracted providers and Allied Health Professionals

• Provides and coordinates telephone intake and crisis intervention services by performing psychosocial assessments and crisis intervention services to patients identified as having psychiatric or chemical dependency problems. • Obtains insurance authorization for patients requiring behavioral health services and facilitates referral to physicians and psychotherapists.

• Provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers • Completes referrals and/or authorizations accurately and consistently with minimal supervision • Processes authorization and referral requests for members in coordination with health plans and contracted providers • Provides support to the Case Management staff • Serves as a resource to providers regarding the authorization process

• Receives incoming inquiries and service requests from patients, employees, providers, vendors and others • Responds to inquiries with accurate and timely information utilizing customer service and quality standards • Works as part of a team to support service delivery teams • Establishes and maintains collaborative relationships with customers to enhance service and satisfaction • Helps foster an environment of continuous improvement in business processes and services • Adheres to local/state/federal regulations to ensure privacy and safety of information

Role Description Conducts preauthorization, concurrent, and retrospective utilization management review using the department’s accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Strives to promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs. Qualifications - Associate Degree in Nursing - Graduate of an accredited school of nursing - RN-Registered Nurse of California - CCM - Certified Case Manager (certification may be required by entity and time to acquire within 2 years of hire) Requirements - 2 years recent relevant experience - A broad knowledge base of health care delivery and case management within a managed care environment. - Comprehensive knowledge of Utilization Review, levels of care, and observation status. - Working knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system, including but not limited to: Centers for Medicare and Medicaid Services (GR) Grouper (CMS), Department of Managed Health Care, National Committee for Quality Assurance (NCQA). - A broad knowledge base of outpatient, acute, and post-acute levels of care and associated regulatory compliance requirements. - Must be able to effectively communicate with and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners. - Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families. - Demonstrates commitment to service excellence in all patients, family, and employee interactions and in performing all job responsibilities. - Functions in a manner to promote quality patient care and assure a positive patient experience. - Verbal and written communication skills. - Interpersonal communication and negotiation skills. - Must have time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities. - Intermediate computer skills. - Ability to promote teamwork and to effectively function in teams. - Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience. Benefits - Comprehensive benefits package

Role Description Receives incoming inquiries and service requests from patients, employees, providers, vendors and others, via phone, email, web portal, etc. and responds to each with accurate and timely information utilizing the highest customer service and quality standards. - Works as part of a team and others to support one or more of the service delivery teams. - Establishes and maintains strong, collaborative relationships with customers to identify additional ways to be of service and ensure customer satisfaction. - Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. - Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety of our employee and patient information. Qualifications - HS Diploma or General Education Diploma (GED) - Medical and Healthcare experience is PREFERRED - 1 year experience in Human Resources, Payroll, Accounts Payable, Supply Chain, call center or related customer service experience (i.e. Healthcare, clinical, administrative, hospitality, retail, concierge, etc) - 1 year experience with computer programs such as Microsoft Office, electronic mail, and information systems or database programs. Requirements - Knowledge of processes within one or more of the following functions desired: Human Resources, Payroll, Accounts Payable, Supply Chain, Revenue Cycle Customer Billing. - Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. - Time management and organizational skills, including the ability to prioritize assignments and work within standardized operating procedures and scientific methods to achieve objectives and meet deadlines. - Requires the ability to work with and maintain confidential information. - Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions. - Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options. - Build collaborative relationships with peers and other healthcare providers to achieve departmental and corporate objectives. - Operate office equipment such as multi-lined phones, printers, faxes, copiers, and scanners. Benefits - Pay Range is $20.26 to $27.36 / hour - The compensation range may vary based on the geographic location where the position is filled. - Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. - Base pay is only one component of Sutter Health’s comprehensive total rewards program. - Eligible positions also include a comprehensive benefits package.

• Aids patients in obtaining the correct level of care with the appropriate provider at the right time • Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support • Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations • Assesses patients' needs, appropriately dispositions cases, collaborates with clinic and hospital-based providers to renew electronic prescriptions, identifies hospital/community resources, consultations/referrals, and performs nursing follow-up activities • Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system

Role Description Supervises and oversees day-to-day activities including implementing protocols and policies and procedures. Manages escalations of complex referrals and internal and external relationship management with high value referring clinicians and unique referring organizations. Establishes work priorities and manages team workload and resources to meet operational goals. Qualifications - Bachelor's: Nursing, Healthcare Administration or related field - Equivalent experience will be accepted in lieu of the required degree or diploma. - 5 years of recent relevant experience. Requirements - Knowledge of principles and practices of patient care, and an understanding of medical diagnoses including medical terminology for all specialties. - Deep understanding of the Epic electronic health record, Microsoft office products and analytical tools. - Knowledge of applicable legislative and regulatory guidelines (e.g., Health Insurance Portability and Accountability Act (HIPPA), The Joint Commission (TJC), and Emergency Medical Treatment and Active Labor Act (EMTALA)) pertaining to healthcare practices. - Knowledge of Stark laws, referral renumeration, safe harbor language and referral legal nuance. - Familiarity and understanding of managed care terminologies. - Demonstrated leadership skills with the ability to mentor, motivate and engage team. - Ability to interpret and apply regulations, policies, procedures, practices, and record keeping requirements. - Ability to identify and analyze trends, determine solutions and resolve operational issues as guided by policies, procedures or practices. - Ability to establish trust and credibility, and to interact and maintain effective working relationships with those contacted in the performance of role’s duties while respecting cultural and linguistic differences and fostering an inclusive work environment. - Ability to communicate through verbal and written means, and to present information to a variety of audiences. - Ability to work effectively in a dynamic and fast-paced environment with changing business priorities. - Organization and planning skills to effectively delegate, manage and/or re-prioritize activities and projects to meet deadlines while delivering quality service and maintaining a high degree of responsiveness. - Displays a customer service focus in all decisions and actions. - Displays integrity and ethics in handling confidential information. - Ability to use essential applications and/or databases associated with the role’s duties and responsibilities. Benefits - Comprehensive benefits package.