"Alerted.org

**Facility:** Corporate Offices

**City** San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree

Hours** **:

Shift Start Time:

8 AM

Shift End Time:

5 PM

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):

$70.010 - $90.340 - $110.660

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

Manage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning activities. Responsible for operational planning consistent with existing policies and/or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory care managers and hospital case management departments. Participates in the development of the annual UM plan and implementation of corrective action plans related to health plan audits and requirements of NCQA. Collaborates with the Quality, Compliance and Training Department to effectively integrate and implement process consistent with Health Plan requirements, NCQA, legislation and CMS. Develops and implements new programs under the direction of the manager of in-patient care management and the Director of Utilization Management.

Required Qualifications

+ 3 Years Experience in the acute patient care setting, including ICU or intermediate care units, Medical-Surgical Nursing, and/or Home Health

+ 3 Years Medical Management experience, preferably in managed care, with supervisory experience

+ 2 Years Medical Management experience, preferably in a managed care setting

+ California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

+ Bachelor's Degree Health care related field

Other Qualification Requirements

+ Utilization, Case Management, or Quality Management certification preferred.

Essential Functions

+ CollaborationEnsures patients are cared for at the appropriate level of care.Coordinates appropriate in-patient utilization of resources to accomplish care management plan and goals.Consults with Hospitalists in a timely and effective manner.Document UR/UM processes according to SCMG policies and procedures.Demonstrates positive and professional communication with patients, family, physicians and other staff.Effective communication skills.Demonstrated organizational, time management, and prioritization skills.Demonstrated conflict resolution ability.Team building, provides direction, goal setting and attainment of goals .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 a Regional team.Active participation on Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional committees.Facilitate UM staff, regional staff and provider staff collaboration.

+ Demonstrates dependability and punctualityTimely notification to supervisor of deviation from scheduled hours.Maintain attendance within SHC and SCMG standards.Consistent and timely attendance at all required departmental meetings.Timely completion of annual TB test, safety test and any other required compliance tests.

+ Human resource managementAll 90 day and annual performance reviews are completed within 30 days of due date.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.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.

+ LeadershipManages UM operations in accordance with National Committee on Quality Assurance (NCQA) and Health Plan requirements.Develop guidelines that have direct impact on the UM Department in 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.Implementation and maintenance of the regular reporting system for operational and utilization outcome indicators.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.Demonstrates resolution of operational issue with targeted outcomes as negotiated with manager or directorActive participation on CQI committee or other process improvement planning committees.

+ Professional developmentKeeps 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.

+ Program improvementMaintains ongoing 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 and agencies, and consultants as appropriateCollaborates with other disciplines/departments to resolve identified issues.

Knowledge, Skills, and Abilities

+ Effective interpersonal skills: strong verbal, written and presentation skills.

+ Ability to work well with staff for various educational and professional skills backgrounds to achieve common goals.

+ Be willing to act. Is not immobilized by fear of failure.

+ Accepts accountability for performance and decisions.

+ Thorough computer knowledge, including on-line database and personal computer skills.

+ Knowledge of wide variety of local and national resources for use in Care Management process.

+ Strong organizational skills with ability to work well under pressure with conflicting priorities.

+ Ability to read, speak and hear English clearly.

+ Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation.

+ Demonstrated leadership skills.

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