Case Manager II- Sharp Tri-City - FT - 8hr Days

Sharp HealthCare; Oceanside (CA); On-site; USD 79,000 - 103,000; Full time

Job summary

Sharp HealthCare in California seeks a Case Manager II to coordinate services and maximize patient outcomes. You will engage in assessment, collaboration, and discharge planning, while acting as a liaison with patients, families, and insurers. Emphasis on cost-effective strategies and evidence-based practices.

The role requires RN licensure in California, a BSN or equivalent CM/UM experience, and strong knowledge of regulatory standards and payer types. Collaboration with care teams is essential.

Qualifications

• RN with CA license is required.
• BSN preferred or 5+ years CM/UM experience in lieu of BSN.
• Minimum 2 years in case management or utilization management.
• Experience with discharge planning and EHR documentation.

Responsibilities

• Coordinate services to maximize patient outcomes.
• Assist in utilization management and discharge planning.
• Act as patient advocate while ensuring confidentiality.
• Document assessments and interactions in the EHR per standards.

Skills

Prospective Payment System

Regulatory standards

Payer types

Communication skills

Education

Bachelor's Degree in Nursing

Associate's Degree in Nursing (5 years CM/UM experience in lieu of BSN)

California RN license

Job description

Hours

Hours:

Shift Start Time: 8:30 AM

Shift End Time: 5 PM

AWS Hours Requirement: 8/40 - 8 Hour Shift

Weekend Requirements: As Needed

On-Call Required: No

Hourly Pay Range (Minimum - Midpoint - Maximum): $57.000 - $66.110 - $75.210

This position is covered by a Collective Bargaining Agreement (CBA) with CNA.

What You Will Do

The Case Manager II assumes responsibility for the coordination of services in order to maximize patient outcomes. Inherent in the position is assessment, evaluation, collaboration and coordination of patient care delivery systems and participation in appointed service line activities. Emphasis is on cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient population. The Case Manager II is responsible for the coordination of utilization management, discharge planning and other health care services/systems. The Case Manager II functions as a contact person, coordinator and facilitator for the patient, family, health care team members and claims/insurance personnel as necessary. The Case Manager II acts as a patient advocate, ensuring dignity and confidentiality. Demonstrate empathy and compassion for patient experience. Advocate for evidence-based practices in case management and utilization review.

Required Qualifications

• Bachelor's Degree in Nursing Or
• Associate's Degree in Nursing with 5 years’ experience as a Registered Nurse in case management in lieu of BSN.
• 2 Years experience as a Registered Nurse in case management or utilization management.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• Accredited Case Manager (ACM) - American Case Management Association (ACMA) -PREFERRED
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Essential Functions

• The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.
  Maintains a safe, clean working environment, including unit based safety and infection control requirements.
  Patient Care:
  Conduct comprehensive assessments to identify patient needs and develop individualized discharge care plans.
  Responsible for the coordination of services in order to maximize patient outcomes.
  Assess, evaluate, collaborate and coordinate patient care delivery systems and participation in appointed service line activities.
  Responsible for the coordination of utilization management, discharge planning and other health care services/systems.
  Functions as a contact person and facilitator for the patient, family, health care team members and claims/insurance personnel as necessary.
  Act as a patient advocate, ensuring dignity and confidentiality.
  Demonstrate empathy and compassion for patient experience.
  Advocate for evidence-based practices in case management and utilization review.
  Safety and Compliance:
  Maintain a safe, clean working environment, adhering to infection control and hospital policies.
  Comply with regulatory standards (e.g., The Joint Commission, OSHA).
  Identify and report safety concerns proactively.
  Ensures cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient populations.
  Documentation:
  Accurately document assessments and patient interactions in the Electronic Health Record (EHR) according to Department Standards.
  Professional Development and Leadership:
  Provide preceptorship and mentorship to New Graduate Nurses, New Hires, and students, supporting their professional development.
  Participate in continuing education and quality improvement initiatives.
  Serve as a resource for best practices within Case Management.
  Emergency Preparedness:
  Activate emergency response system during patient emergencies (e.g., Rapid Response Team (RRT) situations).

Knowledge, Skills, and Abilities

• Knowledge of Prospective Payment System and The Joint Commission standards and regulatory requirements pertaining to Utilization Management and Discharge Planning.
• Proficient computer skills, including Word.
• Knowledge and understanding of various payer types.
• Experience with referral management system.
• Rapid decision-making skills and ability to pivot plans on short notice.
• Ability to prioritize tasks.
• Effective verbal and written communication with the patients, families, and the multidisciplinary team.
• Strong interpersonal skills to support a collaborative team environment.

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, among other things, or status as a qualified individual with disability or any other protected class

Associate's Degree in Nursing; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Certified Case Manager (CCM) - Commission for Case Manager Certification; Bachelor's Degree in Nursing