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Case Manager

Job ID 84924 Date posted 12/19/2017
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Health Services
  • Category: Case Manager Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: Variable
  • Shift End Time: Variable
This position is located in Kearny Mesa, CA (San Diego County)
8-hour day shift; weekends as needed and on-call requirement
12 hour call (phone availability) Sat/Sun/Holidays.  Call shared among the RN’s.  Call requirement every 3rd-4th weekend
Required Skills and Qualifications
  • Graduate of an NLN-accredited School of Nursing 
  • Current, unencumbered California RN license
  • 2-3 years of medical or surgical nursing experience
  • 3 years of Utilization, Quality and/or Case Management experience in managed care
  • Knowledge of current standards of practice and available health resources within the community
  • Demonstrated objectivity and tact in the provision of assistance to members and providers
  • Ability to recognize medically necessary care versus unnecessary or inappropriate service
  • Ability to work well on own, without supervision
  • Knowledge of a variety of health care delivery settings
  • Excellent written and verbal communication skills
  • Organizational, analytical and problem-solving skills
Preferred Skills and Qualifications
  • Bachelor’s degree in Nursing
  • Certified Case Manager (CCM)

The Case Manager is responsible for performing effective acute and ambulatory case management, utilization management and claims review activities to ensure appropriate, cost-effective care to Sharp Health Plan (SHP) members, while always maintaining the highest quality of service.
The Health Services team consists of Case Managers and Care Coordinators.  Sharp Health Plan’s Medical Management department seeks to coordinate services for its members using a team approach to care.  The following programs; case management, disease management, quality improvement and utilization management work together to ensure services are delivered appropriately and in the highest quality possible.  The purpose of the Sharp Health Plan Utilization Management Program is to ensure medically necessary services are rendered at the appropriate level of care in a timely and cost-effective manner.
Sharp Health Plan is San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.
As one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey), Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.
Sharp Health Plan has multiple products and service lines, including but not limited to, HMO, PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange. Contract types to include capitation, fee for service, per diem, medical service agreements, service agreements, P4P, and other risk adjusted agreements as developed in conjunction with health care reform.
Sharp Health Plan has received numerous honors including a4 out of 4-star rating by Covered California for the third consecutive year and SHP is one of only three health plans in California to achieve NCQA’s highest level “Excellent” Accreditation.  We provide a high rated customer service experience.  Sharp Health Plan is the only plan in California to achieve a 4 out of 5 rating for Customer Satisfaction in the National Committee for Quality Assurance (NCQA) Private Health Insurance Plan Ratings 2015-2016.
Essential 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: 84924, RN Case Manager Jobs, RN Case Management Jobs, Utilization Review Jobs, Quality, Nurse, Nursing Jobs, Health Plan, Health Insurance

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