Sharp HealthCare

Manager, Integrated Case Management

Sharp HealthCare

full-time

Posted on:

Origin:  • 🇺🇸 United States • California

Visit company website
✨ AI Apply
Manual Apply

Salary

💰 $67 - $106 per hour

Job Level

Mid-LevelSenior

Tech Stack

AWS

About the role

  • Accountable for development and implementation of Hospital Case Management (HCM) and Ambulatory Case Management (ACM) programs
  • Manage operations of HCM and ACM departments including Pharmacy, referral management, prior authorization, case and disease care management
  • Develop, implement, and update HCM/ACM/Pharmacy policies and procedures in accordance with NCQA, legislative, and health plan requirements
  • Provide direct supervision, leadership, mentoring and staff development for HCM and ACM staff
  • Coordinate interdepartmental projects and represent SCMG in internal and external quality initiatives
  • Ensure regulatory and legislative compliance and timely submission of utilization, case management and disease management work plans
  • Develop and manage departmental budgets and identify cost savings strategies
  • Implement reporting systems, analyze operational and quality outcome indicators, and report results to Quality of Care Committee

Requirements

  • Bachelor's Degree in Nursing OR Bachelor's Degree in Healthcare Administration
  • California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED
  • Master's Degree in nursing, healthcare, quality, or business - PREFERRED
  • 5 Years clinical nursing experience in acute care hospital setting
  • 2 Years management, service line or program experience
  • Certified Professional in Healthcare Quality (CPHQ) - PREFERRED
  • Certified Case Manager (CCM) - PREFERRED
  • Other relevant QM/UM/CM certification preferred
  • Demonstrated working knowledge of managed care, capitation, provider payment mechanisms and member benefits
  • Demonstrated ability to lead staff and daily operations and to develop, implement, and monitor program direction
  • Excellent written and verbal communication, customer service, leadership, analytical and problem-solving skills
  • Strong working knowledge of clinical practice and medical necessity guidelines
  • Strong data management and computer skills
  • Ability to establish strong working relationships with providers, staff, and external customers