• Provide technical direction and guidance to the GEH inspection teams. • Review and analyze automated and manual data with the utmost integrity and strict procedure use and adherence. • Providing technical justification to customers, and regularly interfacing with site Level III's. • Includes direct people management responsibility including staffing and performance development. • Utilizes in-depth knowledge of a technical discipline and analytical thinking and technical experience to execute policy/strategy. • Has knowledge of best practices and is aware of the competition and the factors that differentiate them in the market. • Uses technical experience and analytical thinking to make calls based on best judgement. • Acts as a resource for colleagues with less experience. • May lead small projects with low risks and resource requirements. • Conveys performance expectations and may handle sensitive issues.

• Provide patient-centered, coordinated access to the network of facilities, institutes, and clinics. • Foster and nurture relationships with existing patients and those seeking treatment. • Function as an entry point and informational resource for patients into the health system. • Provide high-touch, personalized assistance to patients across regions and provider networks.

• Perform admission screening for patients in a bed for medical necessity • Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes • Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay • Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients • Provide Physician, Patient, Family, Staff and Student education • Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues • Perform admission necessity screening using criteria as established by the various federal, state and private sector programs

• 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