Sharp Grossmont Hospital is the largest not-for-profit, full-service acute care hospital in the region with 500+ beds. As one of Sharp HealthCare’s superior sites of care, the hospital has outstanding programs in heart care, orthopedics, rehabilitation, robotic surgery, mental health, stroke care and women’s health. In addition, the hospital’s Emergency and Critical Care Center is one of the most technologically advanced emergency and intensive care facilities in the nation.
Sharp Grossmont Hospital is nationally recognized as a MAGNET®-designated hospital for patient care and nursing practices. This designation is the “gold standard” for patient care and nursing excellence and is the highest honor awarded by the American Nurses Credentialing Center.
UR Lead Case Manager
The Lead UR, Integrated Care Management is a crucial member of the leadership team, responsible for oversight and coordination for the day-to-day clinical functions of the UR nurses and utilization review /utilization management processes. Responsibilities include coordinating the daily productivity of the Utilization Review staff, monitoring for quality of service, assisting the Director of Integrated Care Management with operational needs while providing daily team and work direction to achieve or exceed organizational objectives. Core activities include helping to develop and then implement department goals and objectives, achieve appropriate utilization review/management metrics, manage staff/team performance, engagement, customer satisfaction, and participates in new-hire recruitment, orientation, and ongoing time management for assigned staff.
The Lead UR is integral to the effective management of the Integrated Care Management department’s daily operations. Key responsibilities include collaborating with the Director and other Leads to achieve targeted ICM metrics, acting as a resource for internal and external stakeholders, participating and leading meetings, forums, and work-groups to improve departmental processes and provide information to internal and external stakeholders and maintaining knowledge of regulatory and health plan issues and benefits impacting utilization management. S/he is an active participant for the organization’s Utilization Review Committee, providing progress on existing performance improvement initiatives while voicing new and/or emerging trends. The Lead UR manages daily staffing, caseloads and timecards and creates and monitors staff monthly schedules and time reporting. The Lead UR must be able to collaborate and communicate effectively with customers and co-workers to provide a positive work environment and promote teamwork.
The UR Lead Case Manager is part of the Integrated Care Management department. The ICM department at Sharp Grossmont Hospital is comprised of 70+ employees including RN/Social Work Transition Planners, a Utilization Review Nurses, as well as non-clinical resource care coordinators. The department operates as a cohesive, high-functioning team working together to provide resources, ensure safe and sustainable care transitions, and promote continued wellness in this diverse community.
This position is located in La Mesa, CA (San Diego County)
8-hour day shift position with variable start/end times; on-call weekend coverage every 3-4 weeks. Scheduling to be discussed during the interview
Full-time (1.0 FTE) position
Required Skills and Qualifications:
Current unencumbered California Registered Nurse licensure
Two or more years Acute Care or Clinical experience in area of specialty
Advanced clinical skills in area of expertise
2 years recent clinical experience in Utilization Review, Discharge Planning and/or Case Management in a hospital and/or Managed Care setting
Proficient knowledge and understanding of utilization management, healthcare finances, alternative options, goals and outcomes, as well as regulatory and professional implications
Proficient with information systems and computer programs such as Word, Excel, etc.
Effective interpersonal skills: verbal, written and presentation skills
Ability to communicate with patients, families, physicians, and other disciplinary team members effectively
Skilled in conflict management and resolution
Communication and critical thinking skills must be very good to excellent
Self-directed and demonstrates ability to prioritize
Demonstrated ability to remain flexible in rapidly changing environment and current health care dynamic climate
Ability to work collaboratively with interdisciplinary team
Knowledge of team building skills and principles of self-managed work teams
Preferred Skills and Qualifications:
Bachelor of Science in Nursing or health-related field