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Case Manager II, Integrated Care Management, SCMG

Job ID: 96943 Date posted: July 19, 2019

  • Sharp HealthCare
  • Integrated Care Management
  • Day Job
  • Full-Time

Success Profile

Wondering what qualities it takes to be a successful nursing professional at Sharp? View some of the traits we’re looking for below.

  • Innovative
  • Collaborative
  • Resourceful
  • Advocate
  • Person-Centered
  • Critical Thinker

Responsibilities

Summary
The Case Manager II position provides comprehensive management of high-risk patients with complex medical and psychosocial needs requiring resource intensive care management with the goal to improve patient status, patient satisfaction, and patient clinical outcomes.  This involves a collaborative process geared toward coordination of services for the best quality of patient care by following, and monitoring patients throughout the care continuum, facilitating appropriate, timely and efficient utilization of resources, and promotion as well as maintenance of maximum level of patient’s quality of life.  Responsibilities include addressing care coordination, resource management, prior authorization, disease education and self-care counseling, facilitation of referrals to providers, vendors, and community services.  Role also includes patient/family support, empowerment for healthcare decision-making, provision of information and tools for exploring available health care options and advocacy toward the delivery of quality care.  Additionally serves as a knowledgeable resource to all customers served, including, but not limited to Customer Service and Health Services Management Departments.
The Case Manager II position is part of the Integrated Care Management department.  Integrated Care Management is a collaborative integrated approach to care which plans, implements, coordinates, monitors, and evaluates options and services to promote the highest quality and most cost effective outcomes for Sharp Community Medical Group with the goal of maintaining and enhancing each individual’s personal level of wellness
Sharp Community Medical Group (SCMG) is an association of private practice primary care physicians and specialists who practice in their own private offices located conveniently throughout San Diego County. The Sharp Community Medical Group network includes more than 800 primary care and specialty physicians; we're the largest network of private practice doctors in San Diego.  Sharp Community Medical Group cares for more than 350,000 patients each year. With 350 locations in the county, patients and their families will receive extraordinary level of care - right in their neighborhood. 
Location
This position is located in Kearny Mesa, San Diego County
Occasional travel between Sharp HealthCare facilities and provider offices
 
Hours
8-hour day shift, 8:00 am - 4:30 pm; no weekends
Full-time (1.0 FTE) position, 80 hours per pay period
 
Required Skills and Qualifications
  • Education as required for licensure
  • Current unencumbered CA Registered Nurse license
  • 3-5 years of recent hospital experience
  • 3 years experience in Utilization Management and Managed Care
  • Working knowledge of computer programs (Excel, Word, etc.)
  • Broad based knowledge and skills in various medical/surgical and other nursing and health-related specialties
  • Proficient knowledge and understanding of managed care, utilization management, case management, healthcare finances, alternative care options, goals, outcomes, regulatory and professional implications
  • Ability to work independently in research and decision making with minimal direction from supervisory personnel
  • Ability to read, speak and hear English clearly
  • Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation
 
Preferred Skills and Qualifications
  • Bachelor’s degree in Health care
  • BSN strongly desired
  • Experience working in medical group or HMO setting
  • Experience working with complex/catastrophic patients
  • UM, QM or CM certification
  • Case Management certification within one year of hire
  • Bilingual (English/Spanish)

 

Essential Physical Requirements of the position may be discussed during interview.

 

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. 


Keywords: 96943, 92447 

 

Perks

  • Medical, vision and dental

  • Generous time off

  • Flexible schedule

  • Professional growth

  • Wellness Programs

  • Education reimbursement

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Culture/Values

  • Committed to excellence in all that we do
  • Built to be supportive and educational — a place where employees can grow and thrive
  • A positive, compassionate, friendly and team-oriented atmosphere
  • Thankful for the contributions and hard work of others, and praising their accomplishments
  • Committed to creating a safe environment for those we serve
  • Celebrate diversity, recognizing that our unique differences create a stronger whole

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