Supervisor, Utilization Management RN - Los Angeles, United States - L.A. Care Health Plan

L.A. Care Health Plan Los Angeles, United States

3 weeks ago

Description

Salary Range: $102, Min.) - $132, Mid.) - $163, Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the Care Management (CM) staff's responsibilities and activities. This includes, but not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. This role assists in triaging identified issues/problems and forming resolution within the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Care/Case/Utilization Management and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, and escalates issues/concerns to the appropriate person when outside of their scope.

This position is responsible in assisting with and development and maintenance of a successful and cohesive unit, with high level of productivity and accuracy to achieve the department's overall performance metrics. The Supervisor ensures all functions of the UM department are operating in accordance with the organization's mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of LA Care's culturally diverse membership.

The position supports the UM Manager/Director. This role also assists UM Educator/Manager/Director in identification of training needs including, but not limited to, collaborating in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of UM staff. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Ensures adequate/appropriate distributions of workforce, assignments and time off requests. Participates in the hiring and termination process providing recommendations with appropriate supporting documentation.

Monitors of staff's performance including productivity and compliance with regulatory requirements, compliance with policies. Identifies, communicates and coaches to improve staff performance. Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the UM team. Completes intermittent and annual staff evaluations.

Serves as the primary resource for all business-related questions/issues raised by staff; escalates to appropriate leader/team when necessary.

Recommends and implements process improvement measures to achieve department's performance measures outcomes and goals.

Plans and oversees UM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members.

Maintains all assigned reporting responsibilities, conducts regular audits to ensure compliance with community, industry and organizational standards including regulatory requirements. Serves as a super-user on electronic programs and systems used by the department.

Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs. Trains new staff, remediation of seasoned staff and cross training as needed in specified business lines.

Serves as a leader and role model as well as technical and informational resource for staff and peers.

Duties Continued

Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes.

Services as member/resource/liaison to the Interdisciplinary Care Team.

Recommends resources to improve performance standards in terms of Utilization Management. Collaborates with peers and colleagues within the organization to address process improvements, member's needs, department and organizational enhancements and communicate development as appropriate.

Participates on internal and external committees as delegated or assigned.

Serves as a consultant to other departments or organizations as needed.

Performs other duties as assigned.

Education Required

Associate's Degree in Nursing

Education Preferred

Bachelor's Degree in Nursing

Experience

Required:

Minimum of 5-7 years of acute/clinical care experience.

Minimum of 2 years experience in Case/Care/Utilization Management in an acute care or health plan setting.

Minimum of 3-4 years in a lead/supervisory experience.

Skills

Required:

Knowledge of state, federal and regulatory requirements in Care/Case/Utilization Management.

Strong verbal and written communication skills.

Computer literacy with proficiency with Microsoft Word, Excel, etc. and ability to learn core departmental computer systems and software.

Excellent organizational, time management, and interpersonal skills.

Must be detailed-oriented, energetic, and an enthusiastic team player.

Must be able to work independently.

Licenses/Certifications Required

Registered Nurse (RN) - Active, current and unrestricted California LicenseCertified Case Manager (CCM)

Licenses/Certifications Preferred

Required Training

Physical Requirements

Sedentary (occasionally lifting no more than ten pounds, and sitting with occasional walking and standing.)

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Utilization Management Specialist

3 days ago

Keck Medical Center of USC Los Angeles, United States

The Utilization Management Specialist coordinates communication with admitting financial counselors, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. The Utilization Management S ...
Utilization Management Deptartment Lead

3 days ago

Radnet Management, Inc. Los Angeles, United States

Overview: · Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are _Leading Radiology Forward_. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people w ...
Case Manager Utilization Rn-per Diem

1 week ago

Kaiser Permanente Los Angeles, United States

**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
Case Manager Utilization Rn-per Diem Day

1 day ago

Kaiser Permanente Los Angeles, United States

**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
Case Manager Utilization RN-Per Diem Day

17 hours ago

Kaiser Los Angeles, United States Full time

Job Summary: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitaliza ...
Case Manager Utilization Rn, 40/hr Day

3 days ago

Kaiser Permanente Los Angeles, United States

**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
Case Manager Utilization Rn, 24/hr Day

2 hours ago

Kaiser Permanente Los Angeles, United States

**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
Utilization Manager

3 days ago

APLA Health Los Angeles, United States

Job Details · Job Location · Baldwin Hills - Offices - Los Angeles, CA · Salary Range · $80, $106,345.36 Salary/year · Description · POSITION SUMMARY: · This position is responsible for the management of the daily operations of Utilization Management (UM) at APLA Health and ...
Utility Manager

1 week ago

AltaMed Los Angeles, United States

The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and inpa ...
Manager, Utilization Management

1 week ago

Optum Arcadia, United States

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** · Position in this function is responsible ...
Manager Utilization Management

1 week ago

Kaiser Permanente Woodland Hills, United States

**Job Summary**: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utili ...
Manager Utilization Management

2 hours ago

Kaiser Permanente Panorama City, United States

**Job Summary**: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utili ...
Manager Utilization Management

3 days ago

Kaiser Permanente Los Angeles, United States Full time

Job Summary: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilizat ...
Utilization Management Coordinator

2 hours ago

360 Behavioral Health Van Nuys, United States

**Who are we?** · At 360 Behavioral Health, we take pride in our long-standing commitment to providing exceptional care for individuals impacted by autism and other developmental delays. With over three decades of expertise, we are one of the original and most established Applied ...
LVN Utilization Manager

5 days ago

Clinica Romero Los Angeles, United States

Job Description · Job DescriptionSalary: $66,560 - $80,000 · Position Title: LVN Utilization Manager · Department: Medical · Position reports to: Director of Nursing · Position Summary: · The LVN Utilization Manager ensures that health care services are administered with qualit ...
Utilization Management Pharmacist

1 week ago

UnitedHealth Group Inc. Los Angeles, United States

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. · If you are located in PST time zone states, y ...
Manager of Utilization Management, RN

1 week ago

Kaiser Permanente Los Angeles, United States Full time

Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Ca ...
Utilization Management RN

1 day ago

WelbeHealth Los Angeles, United States

Job Description · Job DescriptionAt WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve. · Our Health ...
Project Manager Utilities

1 week ago

Darnell Technical Services Inc Los Angeles, United States

Job DescriptionJob Description · Qualifications: · Bachelors degree or equivalent experience, preferably in a business or technical field. Understanding of Project Management methodology and expertise in using Microsoft Project for tracking and reporting purpose. Experience in ...
Utilization Management Coordinator

1 week ago

360 Behavioral Health Los Angeles, United States

Job Category : Z&S Management Chatsworth Support CenterRequisition Number : UTILI002763Apply nowPosted : April 26, 2024Full-TimeLocations Showing 1 locationVan Nuys, CA 91406, USADescription Who are we?At 360 Behavioral Health, we take pride in our long-standing commitment to pro ...