Manager, Quality and the Medical Management Liaison, RN

We are so glad you are interested in joining Sutter Health!

Organization:

Sutter Health Alliance - Valley

Position Overview:

The Manager, Quality and the Medical Management Liaison RN is a clinically experienced registered nurse leader who directs concierge-level medical management support for a large employer group client of the health plan while also leading the Sutter Health Plan Health and Wellness program. This is a dual-accountability role: it combines hands-on relationship management for a strategically significant client with managerial ownership of a plan-wide program, and requires a leader who can move fluidly between day-to-day service delivery and program-level strategy.

Employer Client Relationship Management

This position serves as the primary point of contact and trusted liaison for the employer client, ensuring a responsive, high-quality service experience through timely communication, proactive issue resolution, and consistent relationship management. The manager coordinates across internal health plan departments and operational teams to resolve plan member healthcare issues, facilitate complaint resolution, support medical appeals, and communicate changes to plan policies and procedures.

Working knowledge of utilization management processes and case management principles is essential to navigating member-level issues, supporting appropriate level-of-care determinations, and connecting members with available clinical resources and programs. This role manages the client relationship with professionalism and accountability, ensuring the employer group receives seamless, coordinated support across the medical management program, and serves as a trusted bridge between the employer group and the health plan advocating for timely issue resolution while ensuring alignment with plan policies, regulatory requirements, accreditation standards, and contractual obligations.

Health and Wellness Program Leadership

This position owns oversight and leadership of the Sutter Health Plan Health and Wellness program, including program strategy, performance monitoring, and ongoing development of program policies and procedures. The manager ensures the program meets regulatory, contractual, and accreditation requirements, and translates program performance into clear, data-driven reporting for operational, committee, and executive audiences.

People and Program Management

As a manager, this role carries direct accountability for staff supervision, workload distribution, and performance management for assigned team members, along with responsibility for hiring, onboarding, and ongoing development of direct reports. The manager builds and maintains detailed program documentation project plans, status trackers, and meeting minutes in accordance with departmental standards, and proactively identifies and communicates risks to program timelines. The role requires the ability to assess and interpret quality and program performance data and translate findings into clear reports and written narratives suitable for operational, committee, and executive audiences. The manager also represents the program and the employer-client relationship in cross-functional and leadership forums and contributes to departmental strategic planning.

Job Description :

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma

• Bachelor's in Nursing

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California

TYPICAL EXPERIENCE:

• 8 years recent relevant experience
• 3 years of utilization management and case management experience strongly desired
• 3 years of program management experience in a managed care or health plan setting strongly desired
• Prior supervisory or people-leadership experience strongly desired
• Project Management Professional (PMP) or Program Management
• Professional (PgMP) certification strongly desired

S KILLS AND KNOWLEDGE :

• Knowledge of ACMA, CMSA, and NASW Standards of Practice.
• Knowledge of available health care and community resources
• A broad knowledge base of health care delivery and case management within a managed care environment.
• Comprehensive knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
• Verbal and written communication skills.
• Group presentation design and facilitation skills.
• Demonstrated ability to develop and manage complex projects.
• Working knowledge of InterQual criteria.
• Working knowledge of MIDAS and experience with an E.H.R. (EPIC preferred)
• Ability to promote teamwork and to effectively function in teams, both as a leader and as a team member.
• Ability to interact effectively with key internal and external constituents using collaboration, negotiation and analytical problem resolution skills.
• Effective human relations and interpersonal skills necessary to lead the efforts of diverse health professionals to meet program objectives.
• Ability to work effectively in a fast paced environment, directing services at multiple locations.
• Analytical and mathematical skills.
• Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements.
• PC skills, word processing, spreadsheets and managed care software programs.
• Adheres to Sutter health policies and procedures and supports Sutter health philosophies and initiatives. Participates as member of the utilization
• Management committee (UMC).
• Strong problem resolution abilities and customer relation skills

Job Shift:

Days

Schedule:

Full Time

Days of the Week:

Monday - Friday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $165,339.20 to $264,555.20 / annual salary

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 candidates experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Healths comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.