Manager Integrated Case ManagementSend to my Email Email a friend Job ID 77147 Date posted 11/04/2016
Requisition ID: 77147
- Facility: Sharp HealthCare
- City: San Diego
- Department: Integrated Care Management
- Category: Nursing Management Jobs
- Job Status: Full-Time
- Shift: Day Job
- FTE: 1.0
- Shift Start: 8 AM
- Shift End Time: 5 PM
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This position is located in Kearny Mesa, CA (San Diego County)
8-hour day shift position 8:00 am - 5:00 pm; no weekends
Required Skills and Qualifications
- Current unencumbered California Registered Nurse license
- Bachelor’s degree in Nursing or Healthcare Administration
- Demonstrated working knowledge of managed care, capitation, provider payment mechanisms and member benefits
- Demonstrated experience and ability to lead staff and daily operations
- Demonstrated ability to develop, implement and monitor program direction and continuous performance improvement initiatives
- Excellent written and verbal communication skills, customer service skills and leadership skills
- Strong working knowledge of clinical practice and medical necessity guidelines
- Strong analytical, problem solving, concurrent and retrospective data management and computer skills
- Ability to establish good working relationships with all levels of support staff, providers, administrative staff and all other internal and external customers
- Demonstrated positive personal influences on teams and customers, including the willingness to accept change proactively
- Demonstrated ability to be flexible and responsive to needs of organization and possess ability to balance the needs of multiple priorities
Preferred Skills and Qualifications
- Master’s degree in nursing, healthcare, quality or business
- 5 years clinical experience in the acute hospital care setting
- 2-3 years of management, service line or program experience
- Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM) or other relevant QM/UM/CM certification
Under the direction of the Sharp Community Medical Group (SCMG) Director for Health Services and in collaboration with the Health Services leadership team, the Manager UM position is accountable for the development and implementation of an effective Hospital Case Management program (HCM) and Ambulatory Case Management (ACM) program that encompasses a “patient centered” care management approach that includes referral management, prior authorization, Case Management and Chronic Care Management and Pharmacy.
The Manager oversees the operations of the Hospital Case Management program (HCM) and Ambulatory Case Management (ACM) department and is responsible for the execution and coordination of all ACM activities including Pharmacy Benefits. Responsibilities include helping to plan, develop, organize, monitor, communicate and recommend modifications to the HCM Program, ACM Program and Pharmacy Program, including all HCM, ACM and Pharmacy policies and procedures. The Manager will coordinate interdepartmental projects to assure quality outcomes, a well as develop and implement operational policies and procedures that have a direct impact on the HCM and ACM programs in accordance with NCQA standards, legislative, and contracted health plan requirements.
The Manager ICM will provide direct supervision of the HCM and ACM staff and models effective leadership and mentoring skills, promote staff development using the concepts and tools supporting the “Sharp Experience” and collaborate with the Sharp Management team to facilitate internal and external committees and/or initiatives to address quality improvement as a representative of SCMG. The role also includes providing support to the VP for Clinical Operations and Health Services leadership team to ensure regulatory and legislative compliance for the division. Under the direction of the SCMG Director for Health Services, the Manager will develop financial (budget) and operational strategies of the HCM and ACM departments.
Sharp Community Medical Group (SCMG) is one of the state's largest and most successful IPAs. Established in 1989, it has over 150,000 members and is comprised of 230+ primary care physicians and 500 specialists. The Health Services Division of SCMG coordinates the medical care of members for inpatient and outpatient services and has a staff of over nurses, pharmacists, social workers, coordinators and support personnel to manage utilization review, case management and quality improvement functions.
Essential Physical Requirements may include
- Ability to sit for extended periods at desk, computer terminal and/or meetings
- Use of personal automobile to meet with providers, health plans and attend meetings
Additional physical requirements of position 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.
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