Hours:

Shift Start Time:

8 AM

Shift End Time:

4:30 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$62.230 - $80.300 - $89.930

 

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
Timely and appropriate coordination of quality healthcare services to meet an individual's specific health needs in a cost-effective manner to promote positive outcomes. Involves a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's healthcare needs through communication and available resources. Addresses care that is client centered, with mutual goals, allowing stewardship of resources for the client and healthcare system.

Required Qualifications

• 5 Years Acute care or clinical experience in area of specialty.
• 2 Years Utilization/Case Management experience, preferably in a Managed Care setting.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED
• AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association -REQUIRED

Preferred Qualifications

• Bachelor's Degree in Nursing or in health related field.
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Essential Functions

• Data collection
  Performs a thorough, systematic, and objective evaluation utilizing standardized tools when appropriate and client involvement in the assessment process and encouraging the client opportunities to communicate and collaborate with the case manager and healthcare team.
  Assessment information is obtained by interviewing the client/family, the primary care physician/provider and/or physician specialists, other members of the healthcare team and other appropriate individuals.
  Assessment should include the following components: physical/functional, psychosocial/behavioral, environmental/residential, family dynamics/support/caregiver capability and availability, spiritual/cultural, financial, learning capabilities/self care, health status expectations/goals, vocational/educational, transitional or discharge plan, and risk management.
  Evaluates objectively and critically all information related to the current and/or proposed treatment plan, potential barriers, goals and objectives, and care alternatives for client.
  Initial assessment is completed within 24 hours of admission per guidelines.
  Assess client healthcare needs and appropriate utilization of services by applying InterQual criteria and/or established and/or established organizational or payer guidelines within 24 hours of admission utilizing the first 12 hours of data to complete admission review.
  Documents assessment and IQ/guideline review data per department standards.
• Demonstrate and maintain adherence to performance indicators
  Demonstrate and maintain adherence to performance indicators while performing services within scope of Case Management (CM) practice.
  Adhere to Case Management performance indicators identified as quality of care, qualifications, collaboration, legal, ethical, advocacy and resource management.
  Work within established standards for healthcare and case management practice and professional discipline.
  Achieve and maintain current professional licensure/certification in case management or in a health services profession directly related to individual's case management practice.
  Maintains continuing competence appropriate to Case Management and professional licensure/certification.
  Provide only those case management services qualified to provide and refer to other sources for services outside case management scope of practice.
  Practices in accordance with applicable local, state and federal laws.
  Knowledge and understanding of applicable accreditation and regulatory statues.
  Practices will be guided by ethical principles governing individual professional licensure/certification. Advocate both for client and payer to facilitate outcomes, however, when conflict arises, needs of client must be priority.
  Evaluate safety, effectiveness, cost and potential outcomes when providing stewardship for ongoing care needs of client.
  Refer, outsource and/or deliver care based on ongoing healthcare needs of client and ability and skill of healthcare provider.
  Promote most effective and efficient use of healthcare services and financial resources.
• Develop and implement
  Develops and implements plan of care which identifies measurable goals that are appropriate to the individual and enhances quality, access and cost-effective outcomes.
  In collaboration with client/family and healthcare team members, identifies immediate, short-term and long-term needs and goals.
  Develops appropriate and necessary case management strategies to address needs and goals. Facilitates proactive discharge planning and healthcare services in accordance with payer contracts and benefit guidelines and/or Medicare guidelines.
  Engages the client/family in the planning process as the primary decision maker and goal setter, educate/prepare the client/family to make informed and appropriate decisions and facilitate enhanced collaboration among all patients to achieve stated goals and to ensure informed decision making. Engages problem-solving skills in order to reconcile potential/actual differing points of view and assure (advocate) wishes and needs for client/family are understood.
  Ensures development of appropriate contingency plans for each step of the healthcare process in the event of health or service complications.
  Ability to recognize that the client plan of care is dynamic and requires ongoing assessments and re-evaluations of health and progress.
  When appropriate, initiates and implements appropriate modifications in plan of care.
  Actively promotes, coordinates and facilitates communication among the client/family, healthcare team members, the payer and other relevant parties.
  Facilitates streamlining the healthcare delivery process to focus on an effective treatment plan for the client, including promotion of timely provision of healthcare and effective utilization of resources.
  Facilitates client education and understanding to prevent risk behaviors and to promote and achieve positive health and wellness outcomes.
  Identifies services that are not medically necessary and/or not covered benefit and appropriately follows payer and/or Medicare guidelines when issuing denial determinations.
  Documents plan of care, goals, outcomes and variances per department standards.
• Plan of care
  Employ process of ongoing assessment, evaluation and documentation to monitor the quality of care, services delivered to the client to determine if the goals of the plan of care are achieved, remain appropriate and realistic and what actions may be implemented to enhance positive outcomes.
  Maintain professional collaboration and communication with client/family so client's health status and impact on the goals and outcomes of the plan of care can be disclosed.
  Maintain professional collaboration and communications with healthcare team members so plan of care can be discussed objectively, problems identified and adjustments made as needed.
  Maintain regular communication with pertinent healthcare providers/payers regarding client transition across healthcare settings.
  Barriers to care/services and strategies or plan revisions needed.
  Performs evaluation at a specified time frame to determine if client's condition has reached a static or regressive situation and proactively facilitates adjustments in the plan of care, providers, and/or services to promote enhanced outcomes.
  Identifies and implements changes in practice patterns and in the plan of care to produce outcomes that are positive, measurable and goal-oriented.
  Documents plan of care, goals, outcomes and variances per department standards.
• Problem resolution
  Identifies opportunities for intervention when there is: lack of established or ineffective treatment plan/specific goals, non-adherence treatment/medications, permanent or temporary alterations in function, medical/psychological/functional complications, lack of resolution in meeting health care needs, lack of education of disease course/process, lack of family/social support, lack of financial resources to meet health care needs and compromised patient safety.
  Identifies opportunities for intervention, which may include analysis of patterns/trends: use of inappropriate services, under and over - utilization of services/providers, and premature or delayed discharge to appropriate level of care.
  Identifies/monitors client's who do not meet clinical criteria for hospital admission and/or continued stay.
  Communicates/collaborates with healthcare team when client does not meet criteria and identifies cost-effective, appropriate alternatives to acute care.
  Documents problem identification per department standards.
• Typing skills
  Using a keyboard, required to type proficiently and accurately.
  Type a minimum of 30 words per minute with 0-2 errors.
  Proof work.

Knowledge, Skills, and Abilities

• Working knowledge of computer programs (Word and Excel) and demonstrates proficiency.
• Advanced clinical skills in area of expertise.
• Proficient knowledge and understanding of utilization management, case management, healthcare finances, alternative care options, goals and outcomes, regulatory and professional implications.
• Skilled in conflict management and resolution.
• Critical thinking skills.

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