Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

Additional Shift Information:

8-HR Var Day shift

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$61.825 - $79.774 - $97.723

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Serves as the primary Integrated Care Management resource on state and federal requirements governing our division. This position works with the System Director and Vice President of ICM to identify areas of risk and act as a consultant to the facility based ICM leaders to develop action plans at a system and local level to drive regulatory compliance. The ICM System Regulatory Specialist is the primary point person for maintaining the system case management policies and procedures. Conducts focused audits and works in collaboration with the SHC Compliance team. Tracks, trends and creates reports to ensure regulatory compliance and works closely with members of the System and Regional/Metro Market Directors to identify gaps, educational needs and shepherd's new regulatory requirements. Reports out audit findings at System and site level meetings. Represents the ICM Senior Leadership as needed.

Required Qualifications

• Bachelor's Degree in Nursing or associated field.
• 3 Years Acute Care Case Management experience.
• California Registered Nurse (RN) - CA Board of Registered Nursing

Preferred Qualifications

• Master's Degree in Nursing or associated/relevant healthcare field.
• 2 Years experience in a CM leadership position.
• 1 Year experience working with a government program.
• 1 Year experience with audits and quality related activities.
• Accredited Case Manager (ACM) - American Case Management Association (ACMA) -PREFERRED
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED
• Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality -PREFERRED

Essential Functions

• Collaboration and Teamwork
  Provides consultation and direction to members of the ICM team and leaders on regulatory requirements.
  Works productively with the various Sharp entities and interdisciplinary team members to foster the integration of policy, procedures, and current and upcoming regulatory requirements.
  Partners with members of the ICM Department at a site and system level to meet key performance indicators and metrics with a focus on revenue protection.
  Identifies through various audit activities opportunities for process improvement as well as areas of risk.
  Exhibit courtesy, cooperation, and respect toward all internal and external customers.
  Demonstrate team behaviors with a commitment to quality. Develop/foster peer relationships that promote efficient integrated departmental operations.
• Communication
  Actively drives ICM Division standardization and change through audit activities.
  Proactively leads potential risk discovery and mitigation discussions.
  Establishes effective working relationships between internal and external customers.
  Highly developed verbal, written, and interpersonal communication skills.
  Deliver answers and solutions within the agreed upon timeframe.
• Financial Accountability
  Partners with other departments such as Revenue Cycle, Quality and Compliance to review cases proactively to identify drift, patterns and trends to achieve optimal financial performance and outcomes.
  Supports Division and Organizational Key Performance Metrics.
• Leadership
  Serve as positive role model to promote employee empowerment, effective leadership, communication and proactive problem solving.
  Facilitates and leads team meetings to review and discuss regulatory audit findings which affect the ICM Division.
  Actively participate in management team meetings by demonstrating creative and effective problem solving/critical thinking skills.
  Ensures required compliance and regulatory education and training is completed within established timeframes.
  Partners with colleagues and system ICM System Clinical Educators to identify educational gaps and needs.
  Responsible for completion and submission of annual reports pertaining to Regulatory Audit and Compliance activities and interventions.
• Professional Development
  Maintains current knowledge of CMS, state and other Federal Regulations and Statutes relevant to Integrated Care Management.
• Quality and Safety
  Through the completion of focused, quarterly performance or adhoc audits identifies opportunities and initiatives to improve work processes and identify risk.
  Utilizes appropriate processes or tools to document identified problems to promptly initiate problem-solving plans.
  Completes quality monitoring tools as specified and participates in the evaluation of such data.
  Keep staff abreast of new developments and Regulatory requirements in collaboration with the System ICM Clinical Educators.
  Ensures staff is knowledgeable and compliant with regulatory and accreditation standards.

Knowledge, Skills, and Abilities

• Proficiency with information systems and computer programs such as word, excel, etc.
• Advanced clinical skills in area of expertise.
• Proficient knowledge and understanding of utilization management, transition planning, alternative options, goals and outcomes, regulatory, and professional implications.
• Ability to organize and prioritize workload with a proven record of timely completion of projects.
• Very good to excellent communication and critical thinking skills.
• Self-directed and demonstrates ability to prioritize.
• Proven attention to detail.
• Demonstrated ability to remain flexible in rapid change environment and current health care dynamic climate.
• Work collaboratively with interdisciplinary team.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing; Master's Degree; Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Bachelor's Degree; Certified Case Manager (CCM) - Commission for Case Manager Certification