Partnership Enablement Manager
Roofr
Manager, Integrated Case Management
Sharp HealthCare
full-time
Posted on:
Location: California • 🇺🇸 United States
Visit company websiteSalary
💰 $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
