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

Sharp Health Plan

Remote, US
Hourly: $57.74 - $83.44; range midpoint: $74.49; n...
Onsite
Acute and ambulatory case management
Utilization management and claims review
Milliman care guidelines application
This position is responsible for performing effective acute and ambulatory case management to ensure appropriate, cost-effective care for Sharp Health Plan members

Job Summary

  • This position is responsible for performing effective acute and ambulatory case management to ensure appropriate, cost-effective care for Sharp Health Plan members.
  • The role requires utilizing the Nursing Process to coordinate care between physicians, specialists, vendors, and community services while developing individualized care plans.
  • Candidates must be authorized to approve medically necessary patient care services using Sharp Health Plan Medical Policies in conjunction with Milliman Care Guidelines.

Matching Summary

This position is responsible for performing effective acute and ambulatory case management to ensure appropriate, cost-effective care for Sharp Health Plan members.

Salary

Hourly: $57.74 - $83.44; Range midpoint: $74.49; Not specified

Skills & Requirements

Must-have

  • Acute and ambulatory case management
  • Utilization management and claims review
  • Milliman Care Guidelines application

Nice-to-have

  • Strong communication and advocacy skills
  • Experience with disease management programs
  • Ability to mentor new case managers

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter