Sharp Rees Stealy - Lead Case Manager - Full Time - Day Shift
- Copley Drive
- Day
- Regular
Hours:
Shift Start Time:
8:30 AMShift End Time:
5 PMAWS Hours Requirement:
8/40 - 8 Hour ShiftAdditional Shift Information:
Weekend Requirements:
No WeekendsOn-Call Required:
NoHourly Pay Range (Minimum - Midpoint - Maximum):
$61.825 - $79.774 - $97.723The 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
Provide leadership and direct supervision for Utilization Management (UM) department staff. Accountable for results of the UM department as measured by monthly metrics and finance reporting. Monitors and coordinates resources to support UM department process and performs ongoing quality improvement.
Required Qualifications
- 3 Years experience required in an acute patient care setting, including ICU or intermediate care units, Medical-Surgical Nursing, and/or Home Health.
- 1 Year Utilization Management/Concurrent review experience.
- California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED
Preferred Qualifications
- Bachelor's Degree in Nursing or other related degree.
Other Qualification Requirements
- California Registered Nurse (RN)-License must be unrestricted. Utilization or Case Management certification preferred. A Utilization or Case Management certification is required within one year from employee's hire date. The department is responsible for tracking and maintaining this certification.
Essential Functions
- Achieves operational outcomes
Has a thorough understanding of SRS payer contracts and benefit guidelines.
Supports timely and correct referral processing and management.
Facilitates staff in prioritizing and problem solving daily operational issues.
Provides on-going education to both clinical and technical staff regarding daily operational issues and health plan delegation.
Ensures department's continual survey readiness. - Leadership
Provides and supports all aspects of leadership, supervision and staffing for the UM Team.
Fosters collaborative, positive working team environment with direct reports.
Ensure staff understanding and support the achievement of UM Department goals, effective case management while maintaining compliance with clinical guidelines and standards.
Ensures that Case Management staff is in regulatory compliance on a daily basis.
Collects, reviews for accuracy and prepares timecards for payroll processing. - Professional competency
A Utilization or Case Management certification is required within one year from employee's hire date. The department is responsible for tracking and maintaining this certification. - Program improvement
Utilizing the Daily Management System (DMS) methodology maintains ongoing analysis of program performance and monitors trends and opportunities for enhancement or expansion of the program.
Provides expertise/consultation in developing services/programs.
Implements effective program improvements and enhancements. - Organizational relationships
Collaborates with other disciplines/departments to resolve identified issues.
Assists Staff in problem solving and prioritization of patient care.
Relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction.
Perform other duties as needed to support the patient population and organization.
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
California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing
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View location"After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it."