Supv Regional Care Mgmt- Integrated Care Mgmt - Sharp Community Medical Group (Corporate) - FT - Days

Care Management Program Manager

Shift Start Time : 8 AM

Shift End Time : 5 PM

AWS Hours Requirement : 8 / 40 - 8 Hour Shift

Weekend Requirements : No Weekends

On-Call Required : No

Hourly Pay Range (Minimum - Midpoint - Maximum) : $70.010 - $90.340 - $110.660

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

Manage an effective in-patient care management program that includes initial and concurrent review; case management / discharge planning activities. Responsible for operational planning consistent with existing policies and / or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory care managers and hospital case management departments. Participates in the development of the annual UM plan and implementation of corrective action plans related to health plan audits and requirements of NCQA. Collaborates with the Quality, Compliance and Training Department to effectively integrate and implement process consistent with Health Plan requirements, NCQA, legislation and CMS. Develops and implements new programs under the direction of the manager of in-patient care management and the Director of Utilization Management.

Required Qualifications

• 3 Years experience in the acute patient care setting, including ICU or intermediate care units, Medical-Surgical Nursing, and / or Home Health
• 3 Years medical management experience, preferably in managed care, with supervisory experience
• 2 Years medical management experience, preferably in a managed care setting
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

Other Qualification Requirements

Essential Functions

Knowledge, Skills, and Abilities

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.