At Sharp, our mission is to improve the health of those we serve with a commitment to excellence in all that we do. We aim to offer quality care and services that set community standards, exceed patients’ expectations and are provided in a caring, convenient, cost-effective and accessible manner.
Our team members are the driving force behind our mission and vision. At Sharp, we’re focused on providing an environment that will meet the needs of both our patients and our employees. Our team members are encouraged to connect with their passions and recommit to the purpose of their work each day.
Complex Case Manager II
In this role, the Complex Case Manager II position will provide comprehensive management of high-risk patients with complex medical and psychosocial needs requiring resource intensive care management with the goal to improve patient status, patient satisfaction, and patient clinical outcomes. This Complex Case Management position involves a collaborative process geared toward coordination of services for the best quality of patient care by following, and monitoring patients throughout the care continuum, facilitating appropriate, timely and efficient utilization of resources, and promotion as well as maintenance of maximum level of patient’s quality of life. Responsibilities include addressing care coordination, resource management, prior authorization, disease education and self-care counseling, facilitation of referrals to providers, vendors, and community services. Role also includes patient/family support, empowerment for healthcare decision-making, provision of information and tools for exploring available health care options and advocacy toward the delivery of quality care. Additionally, serves as a knowledgeable resource to all customers served, including, but not limited to Customer Service and Health Services Management Departments.
The Complex Case Manager II position is part of the Integrated Care Management department. Integrated Care Management is a collaborative integrated approach to care which plans, implements, coordinates, monitors, and evaluates options and services to promote the highest quality and most cost effective outcomes for Sharp Community Medical Group with the goal of maintaining and enhancing each individual’s personal level of wellness.
Sharp Community Medical Group (SCMG) is an association of private practice primary care physicians and specialists who practice in their own private offices located conveniently throughout San Diego County. The Sharp Community Medical Group network includes more than 800 primary care and specialty physicians; we're the largest network of private practice doctors in San Diego. Sharp Community Medical Group cares for more than 350,000 patients each year. With 350 locations in the county, patients and their families will receive extraordinary level of care - right in their neighborhood.
This position is located in Kearny Mesa, San Diego County
Occasional travel between Sharp HealthCare facilities and provider offices
Required Skills and Qualifications:
Education as required for licensure
Current unencumbered CA Registered Nurse license
3-5 years of recent hospital experience
3 years of experience in Utilization Management and Managed Care
Working knowledge of computer programs (Excel, Word, etc.)
Broad based knowledge and skills in various medical/surgical and other nursing and health-related specialties
Proficient knowledge and understanding of managed care, utilization management, case management, healthcare finances, alternative care options, goals, outcomes, regulatory and professional implications
Ability to work independently in research and decision making with minimal direction from supervisory personnel
Ability to read, speak and hear English clearly
Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation
Preferred Skills and Qualifications:
Bachelor’s degree in Health care
BSN strongly desired
Experience working in medical group or HMO setting
Experience working with complex/catastrophic patients
UM, QM or CM certification
Case Management certification within one year of hire
At Sharp, you’ll find the support and flexibility to follow your dreams. At the heart of our organization is our team comprising more than 18,000 nurses, staff, physicians and volunteers — all on a journey to make health care better for our patients and their families. And a big part of that commitment includes making Sharp the best place to work. It’s all part of what we call The Sharp Experience.
At Sharp HealthCare, our mission is to improve the health of everyone we serve. And as San Diego’s leading health care provider, we’re proud to touch the lives of more individuals in our community than any other health care system.