This position is located in Kearny Mesa, CA (San Diego County)
Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation
8-hour day shift, 8:00 am - 5:00 pm; no weekends
Required Skills and Qualifications
Education as required for licensure
Current unencumbered CA Registered Nurse license
Minimum 3-years' experience in a variety of acute patient care settings including ICU or intermediate care units, Medical-Surgical Nursing and/or Home Health
2-3 years Medical Management experience; preferably in a managed care setting
Demonstrated leadership skills
Thorough computer knowledge, including on-line database and personal computer skills
Knowledge of wide variety of local and national resources for use in Care Management process
Strong organizational skills with the ability to work well under pressure with conflicting priorities
Effective interpersonal skills: strong verbal, written and presentation skills
Ability to work well with staff with various educational and professional skills backgrounds to achieve common goals
Able to read, speak and hear English clearly
Able to provide own transportation for travel between Sharp HealthCare facilities and provider offices
Accepts accountability for performance and decisions
Preferred Skills and Qualifications
Bachelor’s degree in Health care
Utilization, Case Management, or Quality Management certification
Experience in a managed care setting
The Supervisor Regional Care Management position will manage an effective Ambulatory Care Management program that includes Disease Management, Wellness, and Prevention and Triage. Responsibilities include operational planning consistent with existing policies and/or principles; managing medical management activities to include tracking, trending and analyzing UM data; and working in collaboration with regional medical directions, ambulatory care managers and hospital case management departments. The Supervisor will participate in the development of the annual UM plan and implementation of corrective action plans related to health plan audits and requirements of NCQA. The Supervisor role also includes collaborating with the Quality, Compliance ad Training Department to effectively integrate and implement processes consistent with Health Plan requirements, NCQA legislation and CMS. The Supervisor develops and implements new programs under the direction of the manager of inpatient care management and the manager of Integrated Care Management.
The Supervisor regional Care Management is part of the Integrated Care Management department of Sharp Community Medical Group (SCMG). Integrated Care Management is a specialty area of practice, where focus is on safe and sustainable care transitions that are efficacious, and which lead to quality outcomes: ensuring patients are in the right care environment, at the right time, and for the right costs. The Sharp Integrated Care Management (ICM) management team is comprised of RN case managers, clinical social work managers and support staff.
Sharp Community Medical Group (SCMG) is one of the state's largest and most successful IPAs. Established in 1989, SCMG cares for more than 350,000 patients each year and is comprised of more than 800 primary care and specialty physicians. SCMG is the largest network of private practice doctors in San Diego. The Health Services division of SCMG coordinates the medical care of members for inpatient and outpatient services and has a staff of over 100 nurses, coordinators and support personnel to manage utilization review, case management and quality improvement functions.
Essential Physical Requirements of position may be discussed during interview
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation, protected veteran status or any other protected class.