Case Manager – Health Services

Role Overview

• Performing effective acute and ambulatory case management
• Conducting utilization management and claims review activities
• Ensuring appropriate, cost-effective care to Sharp Health Plan members
• Maintaining the highest quality of service
• Authorizing medically necessary patient care services
• Coordinating care between the primary physician, specialists, vendors, community services, and client/caregiver
• Developing care plans for the delivery of acute or community-based services
• Conducting claims management services for Sharp Health Plan members
• Providing effective communication and screening of clients
• Serving as a clinical resource for customer service representatives

Requirements

• Graduate of an NLN-accredited School of Nursing
• 2 Years Behavioral Health and Medical Nursing experience
• California Registered Nurse (RN)
• CA Board of Registered Nursing -REQUIRED
• Bachelor's Degree in Nursing (Preferred)
• 3 Years Utilization, quality, and/or case management experience in managed care setting (Preferred)