You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$75.460 - $97.370 - $119.280

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
Supervisory responsibility for the acute care utilization management team. This position supervises, provides oversight and coordination of the day-to-day operations of utilization management. Coordinates the daily productivity of the utilization management team. Drives optimal utilization of services through close coordination and collaboration between payers and site and system Revenue Cycle team members. Supervises staff to ensure all regulatory requirements are met (2MN, Tar Free, etc.) Reports back to the Director of Integrated Care Management. Oversees, implements and supervises all utilization management activities to ensure timely and appropriate authorization for services rendered. Participates as a member of the ICM management team. Maintains an open mind with a passion for departmental growth and program enhancement. Demonstrates out-of-the-box thinking.

Required Qualifications

• Bachelor's Degree
• 2 Years acute care or clinical experience in area of specialty.
• 2 Years clinical experience in Utilization Review, Discharge Planning and/or Case Management in a hospital and/or Managed Care setting.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Bachelor's Degree in Nursing
• Leadership experience.
• Accredited Case Manager (ACM) - American Case Management Association (ACMA) -PREFERRED
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Essential Functions

• Collaboration and teamwork
  
  Provides consultation and direction for Case Manager Utilization Management, and non-clinical support team members regarding cases, policy issues or interdisciplinary matters on which important decisions need to be made.
  Works productively with the various Sharp entities and interdisciplinary team members to foster the integration of policy, procedures, work regulations, and staffing.
  Partners with other members of the ICM Department at a site and system level to meet key performance indicators and metrics.
  Exhibits courtesy, cooperation, and respect toward patients, visitor, physicians and fellow workers to create a positive public image and a harmonic work environment.
  Demonstrates team behaviors with a commitment to quality.
  Develops/fosters peer relationships that promote efficient integrated departmental operations.
  Rotates weekend on call with other members of the site ICM Leadership team.
• Communication
  
  Actively contributes to the leadership team by bringing creative thinking and innovation to assist in enhancing overall operational efficiencies, patient experience and revenue management.
  Participates in a leadership position on an internal quality improvement committee or task force and contributes in a positive manner.
  Establishes effective working relationships between internal and external customers with a focus on payer relationships.
  Participates as a leader with a specialty service lending clinical expertise and leadership and assisting in the growth, development and quality measurement of the specific service.
  Provide staff with information and knowledge that will assist them in their job performance and increase their sense of commitment to the organization.
  Deliver answers and solutions within the agreed upon timeframe.
• Financial accountability
  
  Monitors productivity continuously to meet and exceed established standards.
  Ensures hospital authorizations for services rendered are prioritized.
  Partners with the other members of the ICM leadership to manage length of stay (LOS).
  Assists with management of complex or difficult cases escalated by members of the ICM team.
  Coordinates day-to-day staffing activities, including scheduling, caseload assignments and census flexing.
  Takes initiative in using time effectively and assists team to manage time effectively.
  Seeks to improve systems and processes that ultimately improve staff performance and assist in reducing the overall cost of care.
• Human resource management
  
  Participates in hiring, orienting, and supervising clinical staff.
  Partners with leaders of the ICM team at the site and system levels to create an efficient and effective onboarding process.
  Evaluates staff performance/competency at introductory period and annual review dates; 90-day evaluations and orientation checklists are completed by due date.
  Provides coaching and utilizes SHC performance management guidelines to address staff performance issues.
  Proactively identifies and addresses staff performance issues in a timely/appropriate manner.
  Provides case consultation, professional guidance regarding delivery and services, and consults regarding scheduling and work organization issues.
  Reviews in clinical documentation collaboration with leaders of the ICM leadership team and key stakeholders to ensure staff documentation meets regulatory guidelines.
  Ensures staff compliance with documentation timeframes.
  Ensures all required annual competencies are completed timely and within the outlined timeframes. (UM IRR, annual competency checklist, etc.)
  Supervises flexing, on call skill mix, use of overtime, per diems and registry.
• Leadership
  
  Serves as positive role model to promote employee empowerment, effective leadership, communication and proactive problem solving.
  Demonstrates strong clinical and utilization management skills with patients and families and provides clinical supervision and instruction to CM I and CM II’s.
  Takes active role in coordinating case conferences and escalating patient issues with other members of the Interdisciplinary Care Team (IDT).
  Facilitates and lead team meetings.
  Actively participate in all management team meetings by demonstrating creative and effective problem solving/critical thinking skills.
  Actively participate in intradepartmental task forces.
  Partners with colleagues and system ICM Clinical Educators to identify educational gaps and needs
  Responsible for completion and submission of required reports pertaining to UM CM activities and interventions.
• Professional development
  
  Establishes mutually derived annual goals and meets goals.
  Maintains individual in-service/performance records.
  Ongoing professional growth through attendance at educational forums.
• Quality and safety
  
  Identifies and/or participates in initiatives to improve work processes.
  Audits cases routinely to ensure compliance and drive process excellence.
  Actively practices safe work habits and contribute to ensuring a safe work environment.
  Utilizes appropriate processes or tools to document identified problems to promptly initiate problem-solving plans.
  Promotes quality outcomes in complex, new/unusual, or other high-risk clinical situations, collaborating or seeking additional resources as needed.
  Completes quality monitoring tools as specified and participates in the evaluation of such data.
  Keeps staff abreast of new developments in field, discipline, or functional area.
  Ensures staff is knowledgeable and compliant with regulatory and accreditation standards.
  Makes sound decisions and demonstrates ability to handle situations not covered by written or verbal instructions.
  Notifies appropriate resources when issues or problems arise.

Knowledge, Skills, and Abilities

• Proficiency with information systems and computer programs such as word, excel, etc.
• Advanced clinical skills in area of expertise.
• Proficient knowledge and understanding of utilization management, healthcare finances, alternative options, goals and outcomes, regulatory, and professional implications.
• Skilled in conflict management and resolution.
• Very good to excellent communication and critical thinking skills.
• Self-directed and demonstrates ability to prioritize.
• Demonstrated ability to remain flexible in rapid change environment and current health care dynamic climate.
• Work collaboratively with interdisciplinary team.
• Knowledge of team building skills and principles of self-managed work teams.

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

Bachelor's Degree; Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing