Case Manager – Health Services
Sharp HealthCare
full-time
Posted on:
Location Type: Remote
Location: California • United States
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Salary
💰 $57,740 - $83,440 per year
About the role
- Performing effective acute and ambulatory case management
- Conducting utilization management and claims review activities
- Ensuring appropriate, cost-effective care to Sharp Health Plan members
- Maintaining the highest quality of service
- Authorizing medically necessary patient care services
- Coordinating care between the primary physician, specialists, vendors, community services, and client/caregiver
- Developing care plans for the delivery of acute or community-based services
- Conducting claims management services for Sharp Health Plan members
- Providing effective communication and screening of clients
- Serving as a clinical resource for customer service representatives
Requirements
- Graduate of an NLN-accredited School of Nursing
- 2 Years Behavioral Health and Medical Nursing experience
- California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED
- Bachelor's Degree in Nursing (Preferred)
- 3 Years Utilization, quality, and/or case management experience in managed care setting (Preferred)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
acute case managementambulatory case managementutilization managementclaims reviewcare plan developmentclaims managementpatient care authorizationbehavioral health nursingmedical nursingmanaged care experience
Soft Skills
effective communicationcoordination of carecustomer serviceclinical resource support
Certifications
California Registered Nurse (RN)Bachelor's Degree in Nursing