Sharp HealthCare
SRS-Inpatient Case Manager II - Utilization Management - Per Diem - Days
Sharp HealthCare, San Diego, California, United States, 92189
Hours
: Shift Start Time:
8 AM Shift End Time:
4:30 AM 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):
$60.265 - $77.761 - $95.258 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 The SRS RN CM II assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care. The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Required Qualifications Bachelor's Degree in Nursing 3 Years acute care nursing experience or case management experience 3 Years recent case management, utilization review, care coordination experience California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED
Preferred Qualifications Master's Degree in Nursing Certified Case Manager (CCM) - Commission for Case Manager Certification - PREFERRED
Essential Functions Professional development: Actively participates in the performance planning, competency and individual development planning process. Maintain current knowledge of case management, utilization management, and discharge planning, as specified by Sharp, federal, state, and private insurance guidelines. Core principles: Make timely referrals to ensure that the patient is receiving the appropriate care, in the appropriate setting and using the appropriate utilization standards as set by community and professional standard as adopted by the medical staff. Assure that the patients from all age groups proceed efficiently through the course of hospitalization and beyond through the continuum of care. Relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction. Organizational relationships: Work closely with the healthcare team in reaching unit, facility, and system/network organization goals including reductions in length of stay, decreasing denials, improvement of care transitions, and reduction in avoidable readmissions, improved patient experience, and other quality initiatives. Care coordination and discharge planning: Interview each patient/family for anticipated needs post hospitalization within 24 hours of admission. Document the plan and interventions in the EMR (e.g., Cerner), and case management software (e.g., Allscripts). Develop and document a plan for the day and plan for the stay with patient, family, providers, and nursing staff. Lead the daily care coordination (multidisciplinary) rounds, update the plan, and facilitate necessary coordination of services. Utilization review and utilization management: Conduct initial review at POE or within 24 hours of admission utilizing appropriate care guidelines software. Document findings in CM software. Identify anticipated LOS and document in Allscripts, communicate to healthcare team. Leadership, mentorship: Manage multiple assignments effectively; compose written material; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; and work independently with minimal supervision.
Knowledge, Skills, and Abilities Advanced PC, data management and analysis skills required. An understanding and knowledge of payer eligibility and reimbursement regulations and impact on the continuum of care. Knowledge of use of community resources to coordinate safe discharges from acute care and the ED settings. Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, and across disciplines. Excellent communication and negotiation skills as demonstrated in oral and written forms. Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external. Organizational and time management skills, as evidence by capacity to prioritize multiple tasks. Ability to mentor and lead a team. 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.
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: Shift Start Time:
8 AM Shift End Time:
4:30 AM 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):
$60.265 - $77.761 - $95.258 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 The SRS RN CM II assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care. The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Required Qualifications Bachelor's Degree in Nursing 3 Years acute care nursing experience or case management experience 3 Years recent case management, utilization review, care coordination experience California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED
Preferred Qualifications Master's Degree in Nursing Certified Case Manager (CCM) - Commission for Case Manager Certification - PREFERRED
Essential Functions Professional development: Actively participates in the performance planning, competency and individual development planning process. Maintain current knowledge of case management, utilization management, and discharge planning, as specified by Sharp, federal, state, and private insurance guidelines. Core principles: Make timely referrals to ensure that the patient is receiving the appropriate care, in the appropriate setting and using the appropriate utilization standards as set by community and professional standard as adopted by the medical staff. Assure that the patients from all age groups proceed efficiently through the course of hospitalization and beyond through the continuum of care. Relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction. Organizational relationships: Work closely with the healthcare team in reaching unit, facility, and system/network organization goals including reductions in length of stay, decreasing denials, improvement of care transitions, and reduction in avoidable readmissions, improved patient experience, and other quality initiatives. Care coordination and discharge planning: Interview each patient/family for anticipated needs post hospitalization within 24 hours of admission. Document the plan and interventions in the EMR (e.g., Cerner), and case management software (e.g., Allscripts). Develop and document a plan for the day and plan for the stay with patient, family, providers, and nursing staff. Lead the daily care coordination (multidisciplinary) rounds, update the plan, and facilitate necessary coordination of services. Utilization review and utilization management: Conduct initial review at POE or within 24 hours of admission utilizing appropriate care guidelines software. Document findings in CM software. Identify anticipated LOS and document in Allscripts, communicate to healthcare team. Leadership, mentorship: Manage multiple assignments effectively; compose written material; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; and work independently with minimal supervision.
Knowledge, Skills, and Abilities Advanced PC, data management and analysis skills required. An understanding and knowledge of payer eligibility and reimbursement regulations and impact on the continuum of care. Knowledge of use of community resources to coordinate safe discharges from acute care and the ED settings. Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, and across disciplines. Excellent communication and negotiation skills as demonstrated in oral and written forms. Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external. Organizational and time management skills, as evidence by capacity to prioritize multiple tasks. Ability to mentor and lead a team. 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.
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