Case Manager - Health Services - Sharp Health Plan/remote - Ft - Days

Sharp Chula Vista Medical Center

Remote, US
$57.740 - $83.440 ph
**
Acute and ambulatory case management
Cost-effective care delivery
Authorization of medically necessary services
** Sharp Chula Vista Medical Center is seeking a Case Manager for Health Services to perform case management and utilization management for Sharp Health Plan members. The ideal candidate should be a California Registered Nurse with at least two years of experience in behavioral health and medical nursing. **

Job Summary

  • This position is responsible for performing effective acute and ambulatory case management, utilization management and claims review activities, to ensure appropriate, cost-effective care to Sharp Health Plan (Plan) members, while always maintaining the highest quality of service.
  • Utilize the Nursing Process in the coordination of the delivery of health care services to a specified population of members: Assessment, Planning, Implementation and Evaluation.
  • Provide Prospective, Concurrent, Retrospective and Claims Review and Care Management services for Sharp Health Plan members who are identified as having complex health or functional requirements or are candidates for a disease management program to maximize responsiveness to care plan and attainment of goals.

Matching Summary

Match Score: 75

** Sharp Chula Vista Medical Center is seeking a Case Manager for Health Services to perform case management and utilization management for Sharp Health Plan members. The ideal candidate should be a California Registered Nurse with at least two years of experience in behavioral health and medical nursing. **

Salary

$57.740 - $83.440

Skills & Requirements

Must-have

  • Acute and ambulatory case management
  • Cost-effective care delivery
  • Authorization of medically necessary services
  • Care coordination and advocacy
  • Claims management services
  • Clinical expert for plan standards

Nice-to-have

  • Health education initiatives
  • Client and provider education
  • Continuous learning of medical standards

Key Requirements

  • NLN-accredited School of Nursing Graduate
  • 2 Years Behavioral Health and Medical Nursing experience
  • California Registered Nurse (RN) license

Work Rights

Not specified

Tailored Resume

Cover Letter