Experience Inc. Jobs

Facility: Copley Drive

City San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing

Hours :

Shift Start Time:

8:30 AM

Shift End Time:

5 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):

$61.825 - $79.774 - $97.723

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

Provide leadership and direct supervision for Utilization Management (UM) department staff. Accountable for results of the UM department as measured by monthly metrics and finance reporting. Monitors and coordinates resources to support UM department process and performs ongoing quality improvement.

Required Qualifications

• 3 Years experience required in an acute patient care setting, including ICU or intermediate care units, Medical-Surgical Nursing, and/or Home Health.

• 1 Year Utilization Management/Concurrent review experience.

• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Bachelor's Degree in Nursing or other related degree.

Other Qualification Requirements

• California Registered Nurse (RN)-License must be unrestricted.Utilization or Case Management certification preferred. A Utilization or Case Management certification is required within one year from employee's hire date. The department is responsible for tracking and maintaining this certification.

Essential Functions

• Achieves operational outcomesHas a thorough understanding of SRS payer contracts and benefit guidelines.Supports timely and correct referral processing and management.Facilitates staff in prioritizing and problem solving daily operational issues.Provides on-going education to both clinical and technical staff regarding daily operational issues and health plan delegation.Ensures department's continual survey readiness.

• LeadershipProvides and supports all aspects of leadership, supervision and staffing for the UM Team.Fosters collaborative, positive working team environment with direct reports.Ensure staff understanding and support the achievement of UM Department goals, effective case management while maintaining compliance with clinical guidelines and standards.Ensures that Case Management staff is in regulatory compliance on a daily basis.Collects, reviews for accuracy and prepares timecards for payroll processing.

• Professional competencyA Utilization or Case Management certification is required within one year from employee's hire date. The department is responsible for tracking and maintaining this certification.

• Program improvementUtilizing the Daily Management System (DMS) methodology maintains ongoing analysis of program performance and monitors trends and opportunities for enhancement or expansion of the program.Provides expertise/consultation in developing services/programs.Implements effective program improvements and enhancements.

• Organizational relationshipsCollaborates with other disciplines/departments to resolve identified issues.Assists Staff in problem solving and prioritization of patient care.Relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, collaborate and accept direction.Perform other duties as needed to support the patient population and organization.

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