Case Manager I - Sharp Grossmont Hospital - FT - Days

Hours

Shift Start Time: 8 AM

Shift End Time: 4:30 PM

AWS Hours Requirement: 8/80 - 8 Hour Shift

Weekend Requirements: As Needed

On-Call

Required:

No

Hourly Pay Range (Minimum
- Midpoint
- Maximum): $61,740 - $70,170 - $90,160

The stated pay scale reflects the range as defined by the collective bargaining agreement between Sharp Health Care and Sharp Professional Nurses Network, United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSME, AFL-CIO. Placement within the range is based on years of RN experience.

The RN CM I assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care.

The position creates a balance between individual clinical needs with the efficient and cost-effective utilization of resources while promoting quality outcomes. This position requires critical thinking and advanced problem‑solving and time‑management skills.

• 2 Years recent acute care nursing experience, case management experience or equivalent experience in the healthcare setting.
• California Registered Nurse (RN) – CA Board of Registered Nursing – REQUIRED

• Bachelor's Degree in Nursing or equivalent degree.
• Master's Degree.
• Certified Case Manager (CCM) – Commission for Case Manager Certification – PREFERRED
• Accredited Case Manager (ACM) – American Case Management Association (ACMA) – PREFERRED

• Professional development

  The RN CM I will actively participate in performance‑planning, competency and individual development planning processes and maintain current knowledge of case management, utilization management, and discharge planning as specified by Sharp, federal, state, and private insurance guidelines.

• Core principles

  The RN CM I will make timely referrals to ensure appropriate care settings and utilization standards, assure efficient patient flow through hospitalization, communicate positively and professionally with colleagues, lead and supervise, and perform other duties as needed.

• Organizational relationships

  The RN CM I will collaborate with the healthcare team to achieve unit, facility, and system goals, including length‑of‑stay reductions, decreased denials, improved care transitions, reduced readmissions, and enhanced patient experience. In the emergency department, the RN CM I will work collaboratively to provide pre‑admission status recommendations and implement comprehensive discharge plans.

• Care coordination and discharge planning

  Within 24 hours of admission the RN CM I will interview/assess each patient/family for anticipated needs, ensure patient choice is documented, develop and document plans in the EMR and case‑management software, lead daily multidisciplinary rounds, initiate discharge plans, and facilitate services such as LTAC, SNF, rehab, homecare, and infusion. The RN CM I will collaborate with social workers, prepare patients for discharge, and document all related activities.

• Utilization review and utilization management

  The RN CM I will conduct initial and daily concurrent reviews, identify appropriate patient status and level of care, resolve conflicts with providers, ensure proper documentation, manage Medicare observation status changes, obtain authorizations, refer cases for medical secondary review, support revenue cycle/claims processes, and participate in utilization management meetings.

• PC, data management and analysis skills required (experience with MCG an asset).
• Excellent interpersonal skills, with the ability to work effectively with individuals and teams across disciplines.
• Excellent communication and negotiation skills in oral and written forms.
• Ability to work in a collaborative partnership model with Social Workers and other interdisciplinary members, and strong organizational and time‑management skills to prioritize multiple tasks.

Sharp Health Care is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.