Case Manager I

4 weeks ago


La Mesa, California, United States Sharp Healthplan Full time
Job Summary

We are seeking a skilled RN Case Manager I to join our team at Sharp Healthplan. As a key member of our healthcare team, you will be responsible for assessing, developing, implementing, and coordinating comprehensive plans of care for patients and families in collaboration with physicians, social workers, and other healthcare professionals.

Key Responsibilities
  • Conduct initial reviews at point of entry or within 24 hours of admission to identify anticipated length of stay and document findings in ICM software.
  • Identify and escalate potential quality variances to management and document per guidelines.
  • Collaborate with clinical resource coordinators to ensure appropriate referrals for care and services are directed to network providers.
  • Provide timely delivery of regulatory and mandated patient communications and correspondence.
  • Oversee preparation, delivery, and documentation of non-coverage letters.
Requirements
  • 2 years of recent acute care nursing experience, case management experience, or equivalent experience in the healthcare setting.
  • California Registered Nurse (RN) license.
  • Preferred qualifications include a Bachelor's Degree in Nursing or equivalent degree, Master's Degree, and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM).
About Sharp Healthplan

Sharp Healthplan is an equal opportunity/affirmative action employer. We are committed to providing a work environment that is inclusive and respectful of all employees. We are proud to offer a comprehensive benefits package, competitive salary, and opportunities for professional growth and development.


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