- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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LVN Utilization Manager
Found in: ZipRecruiter Test10S US C2 - 1 day ago
Clinica Romero Los Angeles, United StatesJob 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 ...
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Project Manager Utilities
Found in: Lensa US 4 C2 - 19 hours ago
Darnell Technical Services Inc Los Angeles, United StatesJob 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 ...
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Project Manager Utilities
Found in: Lensa US 4 C2 - 5 days ago
Darnell Technical Services Inc Los Angeles, United StatesJob DescriptionJob Description · Qualifications: · Bachelor's 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 ...
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Utilization Management Coordinator
Found in: Lensa US 4 C2 - 5 days ago
360 Behavioral Health Los Angeles, United StatesJob 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 ...
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Utilization Management Compliance Specialist
Found in: Lensa US 4 C2 - 6 days ago
Imperial Health Plan of California, Inc. Los Angeles, United StatesJOB SUMMARY: Support the Utilization Management (UM )Program and required regulatory deliverables for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, accreditation best practice ...
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Utilization Management Nurse, Senior
Found in: Talent US C2 - 1 day ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will ...
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RN Case Manager/ Utilization manager
Found in: Talent US 2A C2 - 2 days ago
Agama Solutions Inc Los Angeles, United StatesHi, · Hope you are doing great. · My name is Manish Bhati, and I am a Technical Recruiter at Agama Solutions. Agama Solutions is a global contingency staffing firm servicing fortune 1000 clients across South-West America. We have an excellent job opportunity with one of our clien ...
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Supervisor, Utilization Management RN
Found in: beBee S2 US - 1 week ago
L.A. Care Health Plan Los Angeles, United StatesSalary 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 opera ...
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Supervisor - Case Manager/Utilization Review
Found in: Appcast US C2 - 2 days ago
Pyramid Consulting, Inc Los Angeles, United StatesImmediate need for a talented Supervisor - Case Manager/Utilization Review . This is a 03+ Months Contract opportunity with long-term potential and is located in Los Angeles, CA(Onsite) . Please review the job description below and contact me ASAP if you are interested. · ...
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RN Case Manager/Utilization Review
Found in: Talent US C2 - 3 days ago
Keck Medicine of USC Los Angeles, United States Full time· The RN Float Case Manager and Utilization Review Nurse provides coverage for an RN Case Manager or RN Utilization Review Nurse. The RN Float Case Manager and Utilization Review Nurse is assigned to function in the role of either a RN Case Manager or RN Utilization Review Nurse ...
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RN Utilization Management Full Time Days
Found in: One Red Cent US C2 - 4 days ago
MLK Community Hospital Los Angeles, CA, United States Full timeDate Posted: · 3/6/2024 · Job Code: · CareMgrUM · Location: · MLK Community Hospital & Foundation · Address: · 1680 E. 120th St. · City: · Los Angeles · State: · CA · Country: · United States of America · Category: · Care Management/Social Services · Pay Rate Type: · Biweekly · S ...
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Director - Utilization Management
Found in: Lensa US 4 C2 - 1 day ago
Astrana Health Monterey Park, United States· Job Title: Director, Utilization Management · Department: Health Services - UM · About the Role: · Leads and shapes the Utilization Management (UM) Strategy for Astrana Health while providing management oversight in implementing, directing, and monitoring the Utilization Ma ...
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Utilization Management Nurse Specialist RN II
Found in: beBee S2 US - 2 weeks ago
L.A. Care Health Plan Los Angeles, United StatesSalary Range: $88, Min.) - $115, Mid.) - $142, 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 operat ...
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Utilization Management Admissions Liaison RN II
Found in: beBee S2 US - 2 weeks ago
L.A. Care Health Plan Los Angeles, United StatesSalary Range: $88, Min.) - $115, Mid.) - $142, 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 operat ...
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Case Manager Utilization RN-Per Diem Night
Found in: Talent US C2 - 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 hospitaliz ...
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Utility Manager
Found in: Lensa US 4 C2 - 23 hours ago
VALID8 Financial Torrance, United StatesWelcome to IONNA, the joint venture founded by seven global automotive leaders, including BMW, General Motors, Honda, Hyundai, Kia, Mercedes-Benz, and Stellantis. At IONNA, we're revolutionizing the EV charging landscape in North America by creating a high-powered charging networ ...
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Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: Lensa US 4 C2 - 4 days ago
L.A. Care Health Plan Los Angeles, United StatesUtilization Management/Appeals and Grievances Nurse Specialist RN II · Job Category: Clinical · Department: CSC Appeals & Grievances · Location: · Los Angeles, CA, US, 90017 · Position Type: Full Time · Requisition ID: 10893 · Salary Range: $88, Min.) - $115, Mid.) - $142, Max.) ...
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Utilization Management Coordinator
Found in: ZipRecruiter Test10P US C2 - 1 day ago
North American Staffing Group Montebello, United StatesJob Description · Job DescriptionMedica Talent Group is excited to share this temporary opportunity We partnered with a prominent healthcare organization based in Montebello, CA to fill a UM Coordinator position. Please consider applying if you come with a minimum of 2 years of U ...
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Utilization Management Coordinator
Found in: Lensa US 4 C2 - 1 day ago
Cross Country Workforce Solutions Group Montebello, United StatesJob Description · Job Description · Position Summary · This position has primary responsibility for gathering relevant information for the identified member population during assessment, care planning, interdisciplinary care team meeting, and transitions of care. This position ...
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Assistant Nurse Manager, Nursing Administration PD Nights 12hrs
Found in: SonicJobs Direct Apply US - 6 days ago
Kaiser Los Angeles, United States Full timeJob Summary: · For one large unit or more than one smaller unit within a 24 hour department, supervises the implementation, delivery and evaluation/improvement of quality patient care/nursing operations and services that add value and are integrated with nursing standards of prac ...
supervisor, utilization management rn - Los Angeles AFB, CA , USA, United States - L.A. Care Health Plan
Found in: MyJobHelper US C2 - 4 days 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.
Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs.
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 License
Certified 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
Nearest Major Market:
Los Angeles
Job Segment:
Nursing, Registered Nurse, Healthcare