UM Specialist - SNFSend to my Email Email a friend Job ID 77342 Date posted 11/17/2016
Requisition ID: 77342
- Facility: Sharp HealthCare
- City: San Diego
- Department: Sharp Extended Care Dept
- Category: LVN 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 based in Downtown San Diego, San Diego County and will require travel to different San Diego County healthcare locations
8:00am – 5:00pm – Weekends as needed
Required Skills and Qualifications
- Graduate of an accredited Licensed Vocational Nursing (LVN) program or Navy Corpsman School
- Current unencumbered California Licensed Vocational Nursing licensure
- Current Basic Life Support (BLS) certification for Healthcare Providers
- Valid Driver’s license
- Three to five years’ experience in the acute patient care and/or skilled nursing facility (SNF) setting
- Understanding of the federal and state regulations governing skilled nursing facilities
- Knowledge and ability to utilize community resources
- Knowledge of and experience with on-line computer systems
- Excellent verbal and written communication skills
Preferred Skills and Qualifications
- Hospice or Home Health experience
- Experience as a case manager or discharge planner interacting with managed care payers preferred.
- Experience with InterQual or Milliman Guidelines.
- Understanding of the ICD-9 and CPT coding.
- Knowledge of managed care, Health Plan contracts, and benefits
This role will provide comprehensive utilization management and coordination of care for patients who are in a skilled nursing facility. This position will work in collaboration with designated SNF physician or Sharp Community Medical Group primary care physician, as appropriate to ensure cost effective quality service throughout the continuum of care.
Both the Out of Network and Sharp Extended Care Departments are a product of 6 Sigma initiatives developed to serve Sharp Systems Services, Sharp Rees-Stealy Medical Group and Sharp Community Medical Group. The department scope and responsibility is to provide services to all Sharp HealthCare patients throughout the community who are in Out of Network Hospitals and Skilled Nursing facilities.
Sharp Community Medical Group (SCMG) is an association of private practice primary care physicians and specialists who practice in their own private offices located conveniently throughout San Diego County. The Sharp Community Medical Group network includes over 200 primary care physicians and over 700 specialists who currently provide care to more than 137,000 patients. You can expect to receive convenient, comprehensive and high-quality medical care offered by caring physicians who live in your community and are committed to excellence in your health care experience.
Sharp Community doctors admit to all Sharp hospitals and Rady’s Children’s Hospital. In addition, Sharp Community patients have access to urgent care centers throughout the county.
With 450 primary and specialty care physicians providing care at 22 facilities throughout the region, Sharp Rees-Stealy 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-Stealy offers services like laboratory, radiology, physical therapy and urgent care within each clinic or nearby.
Sharp Rees-Stealy has also opened two remarkable state-of-the-art medical office buildings. One located in Downtown San Diego and the other in Sorrento Mesa. Both will provide their communities with leading edge care for decades to come.
Essential Physical Requirements may be discussed at time of 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: LVN, Licensed Vocational Nurse, Utilization, Management, Skilled Nursing, Sub Acute, health plan, insurance, healthcare