UR Lead Case Manager

Job ID: 114826

La Mesa, CA (San Diego County)

$5K Sign-on Bonus. Sharp Grossmont Hospital

Job Summary:

The UR Lead Case manager is responsible for oversight and coordination of the day-to-day operations of case management, utilization review and discharge planning. Responsibilities include coordinating the daily productivity of the case management staff, monitoring for quality of service, assisting the Director of Case Management and Social Work with operational planning and providing daily work direction to achieve organizational objectives. The UR Lead Case Manager focuses on department goals, appropriate utilization, discharge planning, staff/team performance and customer satisfaction.

The UR Lead Case Manager is integral to the effective management of the case management department’s daily operations. Key responsibilities include collaborating with the Director and other Leads to develop/implement procedures to support the operating plan for department, acting as a resource for internal and external stakeholders, participating and leading meetings, forums, and work-groups to improve departmental processes and provide information to internal and external stakeholders and maintaining knowledge of regulatory and health plan issues and benefits impacting utilization management. The Lead Case Manager manages daily staffing, caseloads and timecards and creates and monitors staff monthly schedules and timecards. The Lead Case Manager must be able to collaborate and communicate effectively with customers and co-workers to provide a positive work environment and promote teamwork.

The UR Lead Case Manager is part of the Integrated Care Management (ICM) department. The ICM department at Sharp Grossmont Hospital is comprised of 70+ employees including RN/Social Work Transition Planners, Utilization Review nurses, as well as non-clinical resource care coordinators. The department operates as a cohesive, high-functioning team working together to provide resources, ensure safe and sustainable care transitions, and promote continued wellness in this diverse community.

Sharp Grossmont Hospital is the largest not-for-profit, full-service acute care hospital in the region with 500+ beds. The hospital has outstanding programs in heart care, orthopedics, rehabilitation, robotic surgery, mental health, stroke care and women’s health. In addition, the hospital’s Emergency and Critical Care Center is one of the most technologically advanced emergency and intensive care facilities in the nation.

Sharp Grossmont Hospital is nationally recognized as a MAGNET®-designated hospital for patient care and nursing practices. This designation is the “gold standard” for patient care and nursing excellence and is the highest honor awarded by the American Nurses Credentialing Center.

Qualifications:

Current unencumbered California Registered Nurse licensure

• Two or more years Acute Care or Clinical experience in area of specialty
• Advanced clinical skills in area of expertise
• 2 years recent clinical experience in Utilization Review, Discharge Planning and/or Case Management in a hospital and/or Managed Care setting
• Proficient knowledge and understanding of utilization management, healthcare finances, alternative options, goals and outcomes, as well as regulatory and professional implications
• Proficient with information systems and computer programs such as Word, Excel, etc.
• Effective interpersonal skills: verbal, written and presentation skills
• Ability to communicate with patients, families, physicians, and other disciplinary team members effectively
• Skilled in conflict management and resolution
• Communication and critical thinking skills must be very good to excellent
• Self-directed and demonstrates ability to prioritize
• Demonstrated ability to remain flexible in rapidly changing environment and current health care dynamic climate
• Ability to work collaboratively with interdisciplinary team
• Knowledge of team building skills and principles of self-managed work teams

Preferred Qualifications:

• Bachelor of Science in Nursing or health-related field
• Leadership experience
• Certified Case Manager (CCM)

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.