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Case Manager - UM

Send to my Email Email a friend Job ID 75244 Date posted 08/05/2016
Requisition ID: 75244
  • Facility: SRS Administration
  • City: San Diego
  • Department: Utilization Management
  • Category: Case Manager Jobs
  • Job Status: Per Diem
  • Shift: Day Job
  • FTE: 0.0
  • Shift Start: 8:30 AM
  • Shift End Time: 5 PM
Location
This position is located at the Sharp Spectrum site in Kearny Mesa, CA (San Diego County)
 
Hours
8-hour day shift, 8:30 am - 5:00 pm; no weekends
Per Diem position
 
Required Skills and Qualifications
  • Current, unencumbered California RN license
  • 5 years’ experience in the acute adult patient care setting, including ICU or intermediate care units, Medical/Surgical Nursing and/or Home Health
  • 2 years’ Utilization/Case Management experience, preferably in a managed care setting
  • Advanced clinical skills in area of expertise
  • Self-directed individual and tea player with critical thinking skills
  • Working knowledge of computer programs (Word and Excel)
  • Knowledge and understanding of utilization management, including referral processing, denials, appeals, healthcare finances, alternate care options and regulatory implications
  • Basic ICD-10 and CPT coding knowledge
 
Preferred Skills and Qualifications
  • BSN degree
  • Certified Case Manager (CCM)

Summary
The Per Diem Case Manager UM provides timely and appropriate processing of managed care referrals to meet specific healthcare needs in a cost effective manner utilizing available resources.
This Case Manager position is part of the Utilization Management Department of Sharp Rees Stealy (SRS).  The UM Department staff applies health plan criteria and/or established organizational guidelines to each case review and adheres to all regulatory mandates.  The UM department works closely with the medical staff of SRS and hospitalists, establishing collaborative and professional relationships and are consistently involved in process improvement efforts to identify opportunities for improvement in care management for our members.
With 450 primary and specialty care physicians providing care at 22 facilities throughout the region, Sharp Rees-Steely Medical Group is one of the largest, most comprehensive medical groups in San Diego County, and is recognized for excellence in patient satisfaction and clinical care. For patient convenience and improved coordination of care, Sharp Rees-Steely offers services like laboratory, radiology, physical therapy and urgent care within each clinic or nearby.
Additional physical requirements may be discussed during interview.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class
Keywords:  75244, Case Manager, RN Case Management, CCM, Utilization Management, Nursing Jobs, Sharp Rees Stealy, SRS, San Diego, Per Diem
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