This position is located in Kearny Mesa.
8-hour shift; 8:00 am - 4:30 pm, no weekends
- Bachelor's in related field preferred
- Current unencumbered California Registered Nurse licensure required
- Three to five years experience in the acute patient care setting required, including ICU or intermediate care units, Medical-Surgical Nursing, and/or Home Health.
- One to two years Managed Care/Concurrent review experience required
- Demonstrated leadership skills preferred
- Applies the concepts derived from leadership, interpersonal, and organizational theory to build skills in others or implement programs that support the successful delivery of quality patient care and case management
- Guides others in consistently behaving in accordance with the standards/guidelines of Sharp Health Care regardless of surrounding conditions/activities
- Effective interpersonal skills: verbal, written and presentation skills
The UM Case Manager Lead will provide direct supervision for the UM Department case managers. Collaborates with the Director of UM to develop/implement procedures to support the annual operating plan for the Utilization Management Department. Acts as a resource for internal and external customers in the daily operation of complex case management, prior authorizations, denials and appeals and other office functions/responsibilities and regulatory requirements. Participates in meetings, forums, work groups to represent SRS and maintain knowledge of regulatory issues impacting Utilization Management policies and processes. Collaborates with clinical and clerical staff to ensure authorization process is timely, comprehensive, and appropriate for all payor sources. Manages self, professional responsibility and safety. Processes time cards and checks for accuracy and monitors and tracks overtime.
Sharp Rees-Stealy’s Utilization Management Department is responsible for determining what health care services are covered and payable under the health plan.
With 400 primary and specialty care physicians providing care at 20 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.
Prolonged standing, walking, bending 25 percent of the time. Computer work 75 percent of time. Ability to lift 25 pounds. Prolonged wearing of phone earpiece and frequent phone conversations.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer (M/F/D/V)
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment back ground checks before starting work.
Keywords: 51114, UM Case Manager, Lead, RN, Nursing, Leadership, Utilization, RN Case Management