Case Manager - Health Services - Sharp Health Plan/remote - Ft - Days
Sharp Chula Vista Medical Center
Chula Vista, CA, US
$57.740 - $74.490 - $83.440 ph
**
Acute and ambulatory case management
Utilization management
Claims review activities
**
Sharp Health Plan is seeking a Case Manager for Health Services to perform acute and ambulatory case management, utilization management, and claims review activities. The role requires a California Registered Nurse with experience in behavioral health and medical nursing, focusing on providing cost-effective care and maintaining high service quality.
**
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.
The case manager will coordinate all care, negotiate service arrangements as directed by the Health Services Manager, and ensure that all caregivers and vendors are involved with the care plan.
Provides prompt, accurate and excellent services to internal and external customers.
Matching Summary
Match Score: 75
**
Sharp Health Plan is seeking a Case Manager for Health Services to perform acute and ambulatory case management, utilization management, and claims review activities. The role requires a California Registered Nurse with experience in behavioral health and medical nursing, focusing on providing cost-effective care and maintaining high service quality.
**
Salary
$57.740 - $74.490 - $83.440
Skills & Requirements
Must-have
Acute and ambulatory case management
Utilization management
Claims review activities
Coordination of health care services
Maintain detailed data files
Nice-to-have
Customer service excellence
Professional working relationships
Promote self-awareness and knowledge
Participate in special projects
Key Requirements
Graduate of an NLN-accredited School of Nursing
2 Years Behavioral Health and Medical Nursing experience
California Registered Nurse (RN) - CA Board of Registered Nursing
Bachelor's Degree in Nursing
3 Years Utilization, quality, and/or case management experience