Case Manager I - Case Management - Sharp Grossmont Hospital - FT - Days

Hours Shift Start Time: 8 AMShift End Time: 4:30 PMAWS Hours Requirement: 8/80 - 8 Hour ShiftWeekend Requirements: As NeededOn-Call Required: No Pay Range Hourly Pay Range (Minimum - Midpoint - Maximum): $61.740 - $70.170 - $90.160 Stated pay scale reflects the range defined by the collective bargaining agreement between Sharp HealthCare, 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. What You Will Do 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 role combines clinical/quality considerations with regulatory/financial/utilization review demands to assure patients receive care in the appropriate setting and level of care. The RN CM I creates a balance between individual clinical needs and efficient, cost-effective resource utilization while promoting quality outcomes, critical thinking, advanced problem‑solving and time management skills. Required Qualifications 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. Preferred Qualifications 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. Core Functions and Responsibilities Professional development: Actively participate in performance‑planning, competency and individual development planning processes. Maintain current knowledge of case management, utilization management and discharge planning as specified by Sharp, federal, state and private insurance guidelines. Clinical duties: Make timely referrals to ensure patients receive appropriate care in the appropriate setting using community and professional standards. Ensure patients of all age groups proceed efficiently through hospitalization and beyond, communicating positively, effectively and professionally, being assertive, following policies, calm under pressure, and leading and teaching colleagues. Team collaboration: Work closely with the healthcare team to meet unit, facility and system/network goals, reduce length of stay, decrease denials, improve transitions of care, reduce readmissions and enhance patient experience. In the emergency department, collaborate with the interdisciplinary team to develop admission relationships, provide pre‑admission status recommendations, and implement comprehensive discharge plans from the ED for patients discharged to a lower level of care. Care coordination and discharge planning: Within 24 hours of admission interview and assess each patient/family for anticipated needs. Document patient choice, plan and interventions in the electronic medical record (EMR) and case management software. Lead daily multidisciplinary care coordination rounds, update plans and facilitate service coordination. Initiate discharge plans including early referrals and authorization for LTAC, SNF, rehab, homecare, DME and infusion services. Prepare patients/families for discharge, document expected discharge date and arrange pick‑up appointments. Follow standards for routine patient/family conferences and ensure effective, safe handovers to next level of care. Utilization review and management: Conduct initial review at POE or within 24 hours of admission using evidence‑based care guidelines. Identify anticipated LOS, conduct daily concurrent reviews, ensure correct patient status and level of care, resolve documentation conflicts with providers, and maintain Medicare/Observation status changes per regulations. Communicate with payers for authorizations, obtain approved LOS, refer cases for medical secondary review, participate in RAC decisions, identify cost reduction opportunities and refer cases for physician advisory or medical director consultation when needed. Knowledge, Skills, and Abilities PC, data management and analysis skills required (experience with MCG an asset). Excellent interpersonal, communication and negotiation skills. Ability to work in a collaborative partnership model with social workers and interdisciplinary team members, internally and externally. Organizational and time management skills, evidenced by capacity to prioritize multiple tasks. EEO Statement Sharp HealthCare 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, or status as a qualified individual with disability or any other protected class. #J-18808-Ljbffr