Job Description:Provide clinical guidance, supervise and monitor the care management team with focus on appropriate care , case escalation, customer service and appropriate outcomes.
Job Responsibilities- Provide clinical expertise, guidance and supervision to the care management team including clinical and non-clinical staff. Lead by example and act as a resource to staff by resolving clinical and benefit issues.
- Manage staff production to ensure turnaround times, in-patient visists and patient calls, are meeting department goals
- Research, file preparation and readiness for health plan audits
- Assist in setting and achieving unit and department goals/standards consistent with business objectives.
- Monitor productivity and other metrics to ensure department goals/priorities are met
- Support implementation of department policies and procedures.
- Participate in recruitment, retention of staff, and training.
- Support a positive work environment, motivating staff and fostering teamwork.
- Evaluate employee performance and provide appropriate feedback.
- Serve as a resource for physicians, providers, members and staff.
- Meet with staff, communicate and receive feedback on operational issues.
- Communicate and reinforce department policy and procedures. Participate in annual review and revision while collaborating with other regions to ensure consistency in application.
- Share accountability for managing the department budget and ensuring appropriateness of expenditures such as supplies and overtime.
- Conduct patient outreach and manage escalations as necessary.
- Other duties as assigned.
Required Experience- Active, unrestricted California Licensure: Registered Nurse (RN) preferred or Licensed Vocational Nurse (LVN).
- Minimum three years clinical nursing experience.
- Minimum two years utilization management experience, preferably in managed care.
- Supervisory experience and/or demonstrated leadership skills preferred.
- Strong leadership, organizational, and communications skills.
- Ability to work effectively with a variety of customers including physicians, managers, providers, office staff, health plans and internal staff members.
- Proficient in MS office applications.
- Strong computer skills for application implementation and monitoring as well as mentoring staff on these applications.
- Experience with Epic/Tapestry preferred.
Additional InformationSalary: $106,000 - $135,000 Annual
