Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$71.822 - $92.673 - $113.525

The 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
To manage effective Population Health Care Management programs that includes all components of case management activities; responsible for operational planning consistent with existing policies and/or principles and managing Population Health medical management activities to include tracking, trending and analyzing data. Develops and implements new programs under the direction of the Manager of Disease Management and Director of Population Health. Collaborates with the Continuum of Care departments to effectively integrate and implement processes consistent with Health Plan, NCQA, legislation and CMS requirements. Participates in the development of the annual Disease Management Plan and evaluation and implementation of polices and guidelines to meet NCQA standards; takes a lead role in NCQA and health plan audits and chart reviews.

Required Qualifications

• Bachelor's Degree Health related field.
• Computer experience to include online database.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Master's Degree
• 3 Years Experience in a variety of acute patient care settings.
• 2 Years Medical Management experience including case management and leadership skills.
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Essential Functions

• Action plans
  Identifies and implements action plans that result in program enhancement.
  Maintains on-going analysis of program performance and monitors trends and opportunities for enhancement or expansion of the program.
  Provides expertise/consultation in developing services/programs, marketing strategies, and business planning.
  Consults/liaisons with other programs, departments and agencies, and consultants as appropriate.
  Collaborates with other disciplines/departments to resolve identified issues.
• Adheres to highest standards of performance by keeping skills and competencies up to date through professional development, identifying gaps in skills and competencies and seeking the knowledge and training necessary to perform at and above standards.
  Keeps current knowledge and understanding of applicable accreditation and regulatory statutes related to health care, managed care, case management practice.
  Serves as a resource and mentor to regional team and other department staff.
  Establish mutually derived annual goals and meet goals.
  Maintain individual in-service/performance records.
  Attends and actively participates in department/team process/quality improvement activities.
• Care management
  Works collaboratively with Medical Directors, staff, physicians and their staff, hospital personnel, UM team, SRS Care
  Management Programs and multidisciplinary team to facilitate positive hospital and physician relationships, education and decrease barriers to appropriate, quality patient care.
  Ensures patients are cared for at the appropriate level of care.
  Coordinates appropriate outpatient utilization of resources to accomplish care management plan and goals.
  Document UR/UM processes according to SRS policies and procedures.
  Practice positive and professional communication with patients, family, physicians and other staff.
  Resolve conflicts in a professional manner following Sharp’s Behavior Standards.
  Utilizes team building skills to provide direction, goal setting and attainment of goals.
  Collaborates with Physicians to address operational issues.
  Collaborates with other disciplines/departments to resolve identifies issues with demonstrated improvement in operational flow.
  Active participation on Collaborative Workgroup and Continuum of Care.
  Facilitate staff and provider collaboration.
• Demonstrates dependability and punctuality
  Follows all departmental safety policies and procedures.
  Maintain attendance within SHC and SRS standards; reports to work on time or notifies supervisor of deviation from scheduled hours.
  Consistent and timely attendance at all required departmental meetings.
  Timely completion of annual TB test, safety test and any other required compliance tests.
• Department supervision and management
  All 90 day and annual performance reviews are completed within 30 days of due date. Provides feedback about employees’ performance both constructive and positive. Coaches staff in resolution of conduct issues or enhancement of performance.
  Assure employee files are current and complete, including annual PPD, CPR, safety test, annual HIPAA test, etc.
  Manage and assist staff to resolve identified attendance, performance, learning and behavior issues through feedback, counseling, corrective action and goal-setting.
  Assures appropriate hiring/staffing for department. Hire staffing for the department per department plan.
  Orient/mentor staff into new role resulting in achieved competencies.
  Develop staff’s leadership skills.
  Develop new area of expertise relevant to human resource management.
  Mentors others in developing new skills and assuming new responsibilities.
  Increases retention rate (or reduces turnover) of select group of staff.
  Facilitates the constructive resolution of inter-group/interdisciplinary conflict.
  Leads initiative that results in improved teamwork and/or building more effective relationships.
  Decreases occurrences of unsafe work practices and/or worker’s injuries.
  Establish and maintain routine 1:1 meetings with staff on at least a quarterly basis.
• Operational management
  Holds self and others accountable for meeting operational goals of assigned units or departments. Aligns expectations with organizational vision and service-culture initiatives.
  Manages Care Management operations in accordance with National Committee on Quality Assurance (NCQA) and Health Plan requirements.
  Develop guidelines that have direct impact on the Care Management day-to-day operations and flow of information and human resource issues.
  Establish and maintain appropriate policies and procedures and training plans. Collaborate with the Quality, Compliance and Training department to ensure timely and relevant implementation of training and verify adherence with compliance and quality parameters. Enforce policies and procedures for all Care Management activities.
  Leads groups in developing and implementing strategic plan to implement organization vision and/or service culture initiatives.
  Establishes specific quality goals, connecting the vision to the necessary actions and long term strategies.
  Demonstrates improved quality or operational outcomes due to intervention with other staff, clinicians, or physicians.
  Recognizes physician needs and concerns and initiates opportunities for improvement.
  Recognizes patient needs and concerns and initiates opportunities for improvement.
  Collaborates with other disciplines/departments to resolve daily operational issues when supervising unit.
  Facilitates staff in prioritizing and problem solving daily operational issues.
  Provide resolution to operational issues according to targeted outcomes as determined with manager and/or director.
  Actively participate in process improvement planning committees and other committees as assigned.

Knowledge, Skills, and Abilities

• Must have own transportation or a means to travel between Sharp HealthCare facilities and provider offices.
• Knowledge of wide variety of local and national resources for use in Care Management processes is preferred.

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

Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; Bachelor's Degree