Sharp HealthCare

Nurse

• Assist patients, staff, and physicians to maintain operational efficiency, customer service, and quality care
• Demonstrate clinical knowledge and skills within scope of practice
• Perform and assist with tests and procedures
• Administer medications safely and accurately, with required verification and documentation
• Prepare patients for examinations and procedures; obtain consents; prepare and label biopsies
• Document patient care accurately according to protocol
• Listen to patients, collect information, assess urgency, and route issues to physicians
• Return phone calls and may schedule patient appointments
• Provide patient education in partnership with physicians
• Follow universal precautions and infection-control policies
• Assist PSRs with scheduling and telephone-management issues
• Participate in clinical projects directed by physicians or managers
• Organize daily department requirements and monitor patient flow and physician schedules
• Manage telephone messages and troubleshoot problem calls
• Enter OCM and IDX information according to policy
• Respond to urgent and emergent situations and prioritize patient needs
• Maintain supplies, inventories, reports, and inspection readiness
• Enter authorizations and schedule surgeries and procedures
• Assist in other departments and travel to other sites as business needs arise
• Complete nursing competency testing and quality-assurance assignments
• Maintain narcotic-control procedures and assist with prescription reconciliation
• Support quality initiatives including P4P, BMI, and DataMart
• Operate department equipment and information systems
• Activate emergency procedures and complete AEHR tasks
• Support new applications and policies

Nursing Float Pool – LVN

General

• Code diagnoses and applicable procedures for Emergency Department, Infusions Wound Care Clinic, and Outpatient Ancillary encounters using HCPCS/CPT and/or ICD-10-CM
• Maintain a safe, clean working environment, including unit-based safety and infection control requirements
• Code encounters according to Hospital-Based and quality monitoring criteria
• Observe and report unusual documentation patterns requiring additional research for coding completion
• Maintain ongoing education for current professional certification
• Review and comprehend current coding and compliance information
• Adhere to AHIMA Standards of Ethical Coding
• Perform other related duties as requested by Management

Coder II

Accountant

• Produce reports and prepare data for financial statements, regulatory reporting, external audits, medical cost ratios, third party liability, claims recovery, and other financial information
• Audit capitation, pharmacy payments, and broker and general agency commissions
• Support accounting and finance activities as needed
• Assist with budget development, refund, and returned check processes
• Assist with the annual budget process by updating spreadsheets with actual data and management budget assumptions
• Maintain monthly documentation of medical groups, rates, and dollar amounts comprising monthly capitation cost
• Post claims recoveries to the IDX MCA system and produce refund requests for erroneous duplicate collections
• Research and resolve returned claims checks and other claim refunds
• Provide prompt, accurate service to internal and external customers
• Develop professional working relationships with internal departments, vendors, providers, employers, brokers, and other customers
• Assist in preparation of financial reports
• Participate in special projects, work groups, proposals, audits, and backup support
• Prepare assigned regulatory reports, including DMHC financial information and informational 990 tax filing
• Utilize Data Warehouse and Excel to supply routine and ad hoc reports
• Work closely with Sharp Health Plan and Sharp HealthCare department members to ensure efficient communication and operations

Staff Accountant

Manager

• Support utilization review functions from pre-admission through discharge and final status reconciliation
• Ensure timely interaction with admitting and attending physicians, payers, physician advisors, and interdisciplinary care teams
• Coordinate utilization management activities with Revenue Cycle
• Ensure compliance with local, state, and federal utilization review and care management regulations
• Perform initial and concurrent reviews for intent-to-bed and bedded patients
• Identify and escalate cases that do not meet admission or continued-stay criteria
• Advise physician advisors and help mitigate denials
• Review hospitalized patients with Physician Advisors or facility UR chairpersons
• Identify and report emerging variances and trends
• Maintain utilization records and statistics, including bed days, discharges, readmissions, and diagnoses
• Complete documentation accurately and on time
• Coordinate transfers of out-of-network patients when indicated
• Maintain confidentiality of patient and utilization management information
• Participate in ICM care conferences and utilization review projects
• Maintain logs and reports for high-risk, long-stay, and outlier patients
• Facilitate information sharing and project coordination across teams and facilities
• Develop collaborative relationships with nursing departments, payers, hospitals, physicians, and medical groups
• Mentor new hires and orientees under the direction of ICM Centralized UM leadership
• Drive departmental excellence, process improvement, and team performance
• Participate in professional development and identify performance improvement opportunities

Utilization Manager II

Patient Service Representative

• Perform patient scheduling, reception, and assigned department operational tasks
• Participate in customer service performance improvement projects
• Greet patients, providers, staff, and team members professionally
• Explain provider delays and assist with initial patient paperwork
• Maintain confidentiality and clinic workflow
• Confirm patient information and schedule appointments accurately
• Register patients in electronic health record systems
• Maintain efficiencies in scheduling with leadership and providers
• Create, distribute, and maintain patient charts and medical records
• Request archived records and pull onsite paper charts when needed
• Answer telephones within three rings, transfer calls, and take complete messages
• Support cost containment and use time effectively
• Set priorities and adjust to unscheduled situations
• Complete quality assurance and monitoring tools
• Document problems and initiate problem-solving plans
• Collaborate with resources to promote quality outcomes
• Stay current with developments in the field

Program Manager

• Manage approximately $50M-$100M per year of supplies and services across medium-to-high complexity and risk categories
• Provide strategic decision-support and recommendations to clinical and non-clinical stakeholders
• Lead data-driven sourcing initiatives using market and competitive analysis, leverage creation, and professional negotiations
• Develop sourcing strategies, identify supply alternatives, recommend sourcing approaches, and establish project plans and timelines
• Maintain contract calendars and collaborate with product committees and clinical consultants
• Analyze contracts with Legal and ensure Sharp HealthCare's interests are met
• Publish the contract portfolio and drive compliance with committed contracts
• Monitor category spend, expense trends, variances, savings goals, and cost impacts
• Perform supplier, market share, pricing, budgeting, trend, and contracting-impact analyses
• Develop category sourcing plans and 3-5 year strategies
• Communicate category trends and upcoming changes to stakeholders
• Lead multidisciplinary category teams and clinical/process improvement initiatives
• Conduct supplier evaluation, qualification, selection, RFP/RFQ bidding, negotiations, and contract execution
• Develop supplier selection criteria and facilitate committee reviews and approvals
• Review catalog item additions and maintain department files and contract information
• Meet with vendors regarding contract terms, compliance, supply failures, and improvement options
• Participate in Value Analysis teams and maintain contract database integrity
• Run and resolve Supply Chain data audits
• Participate in MMIS or new technology system testing
• Perform miscellaneous job-related duties as assigned

Nursing Float Pool – LVN

Coder II

Staff Accountant

Utilization Manager II

Patient Service Representative

Program Manager – Sourcing Category Management