Quality and Regulatory Specialist-icm

2 weeks ago

San Diego, United States Sharp Healthcare Full time

[Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing; Master's Degree; Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Bachelor's Degree; Certified Case Manager (CCM) - Commission for Case Manager Certification
**Hours**:
**Shift Start Time**:
Variable
**Shift End Time**:
Variable

**AWS Hours Requirement**:
**Additional Shift Information**:
8-HR Var Day shift

**Weekend Requirements**:
As Needed

**On-Call Required**:
No

**Hourly Pay Range (Minimum - Midpoint - Maximum)**:
$61.825 - $79.774 - $97.723

**What You Will Do**
Serves as the primary Integrated Care Management resource on state and federal requirements governing our division. This position works with the System Director and Vice President of ICM to identify areas of risk and act as a consultant to the facility based ICM leaders to develop action plans at a system and local level to drive regulatory compliance. The ICM System Regulatory Specialist is the primary point person for maintaining the system case management policies and procedures. Conducts focused audits and works in collaboration with the SHC Compliance team. Tracks, trends and creates reports to ensure regulatory compliance and works closely with members of the System and Regional/Metro Market Directors to identify gaps, educational needs and shepherd's new regulatory requirements. Reports out audit findings at System and site level meetings. Represents the ICM Senior Leadership as needed.

**Required Qualifications**
- Bachelor's Degree in Nursing or associated field.
- 3 Years Acute Care Case Management experience.
- California Registered Nurse (RN) - CA Board of Registered Nursing

**Preferred Qualifications**
- Master's Degree in Nursing or associated/relevant healthcare field.
- 2 Years experience in a CM leadership position.
- 1 Year experience working with a government program.
- 1 Year experience with audits and quality related activities.
- Accredited Case Manager (ACM) - American Case Management Association (ACMA) -PREFERRED
- Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED
- Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality -PREFERRED

**Essential Functions**
- Collaboration and Teamwork
Provides consultation and direction to members of the ICM team and leaders on regulatory requirements.
Works productively with the various Sharp entities and interdisciplinary team members to foster the integration of policy, procedures, and current and upcoming regulatory requirements.
Partners with members of the ICM Department at a site and system level to meet key performance indicators and metrics with a focus on revenue protection.
Identifies through various audit activities opportunities for process improvement as well as areas of risk.
Exhibit courtesy, cooperation, and respect toward all internal and external customers.
Demonstrate team behaviors with a commitment to quality. Develop/foster peer relationships that promote efficient integrated departmental operations.
- Communication
Actively drives ICM Division standardization and change through audit activities.
Proactively leads potential risk discovery and mitigation discussions.
Establishes effective working relationships between internal and external customers.
Highly developed verbal, written, and interpersonal communication skills.
Deliver answers and solutions within the agreed upon timeframe.
- Financial Accountability
Partners with other departments such as Revenue Cycle, Quality and Compliance to review cases proactively to identify drift, patterns and trends to achieve optimal financial performance and outcomes.
Supports Division and Organizational Key Performance Metrics.
- Leadership
Serve as positive role model to promote employee empowerment, effective leadership, communication and proactive problem solving.
Facilitates and leads team meetings to review and discuss regulatory audit findings which affect the ICM Division.
Actively participate in management team meetings by demonstrating creative and effective problem solving/critical thinking skills.
Ensures required compliance and regulatory education and training is completed within established timeframes.
Partners with colleagues and system ICM System Clinical Educators to identify educational gaps and needs.
Responsible for completion and submission of annual reports pertaining to Regulatory Audit and Compliance activities and interventions.
- Professional Development
Maintains current knowledge of CMS, state and other Federal Regulations and Statutes relevant to Integrated Care Management.
- Quality and Safety
Through the completion of focused, quarterly performance or adhoc audits identifies opportunities and initiatives to improve work processes and identify risk.
Utilizes appropriate processes or tools to document identified problems to

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