Nurse Supervisor, Healthcare Services Utilization Management ( California )

Job Summary

Leads and supervises a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• California licensure must be current and in good standing.

Preferred Qualifications

• LVN (Licensed vocational nurse) or RN (Registered Nurse). License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.

Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.