Supervisor, Utilization Management Clinical, RN - Inpatient
Location: Rancho Cucamonga
Posted on: April 4, 2021
Position Summary/Position Under the direction of the Inpatient
Review Nurse Manager, the UM Clinical, RN Supervisor will oversee
Inpatient review clinical and non-clinical Team Members within
their respective Team Centers as well as work with facilities and
IPAs to ensure coordinated and continuous cost- effective quality
healthcare is delivered to IEHP Members.
Major Functions (Duties and Responsibilities) 1. Responsible for
the oversight of Inpatient Review and collaborative interactions
with the other departments within IEHP and external partners.2.
Provide leadership and supervision of day-to-day inpatient UM
functions to ensure high quality, cost-effective services to
Members and ensure clinical regulatory compliance.3. Ensure minimum
productivity standards are met, including assisting current
workload when timely review and/or discharge may be in jeopardy.4.
Promote and ensure adoption of best practices utilizing Lean
techniques and monitor clinical metrics in a transparent manner
with Team Members and UM Management to ensure targets are met.5.
Serve as a resource to department team members, internal and
external partners regarding inpatient UM regulations and
processes.6. Assist with the creation and implementation of
standard operating procedures, job aides, policy and procedures in
alignment with department and organizational strategic
priorities.7. Accountable for the promotion of continued
professional growth, training and education of self and team
members as evidenced by attendance at leadership trainings, CEU
events, etc.8. Assist with identifying network opportunities based
on vendor and specialty gaps and work with UM management, Provider
Relations, and the Contracts Departments to ensure an extensive
network exists at all times.9. Assist with planning, development,
and implementation of new UM software.10. Responsible for providing
oversight of concurrent and retrospective reviews for medical
necessity per evidence based criteria, appropriateness of service
and level of care.11. Responsible for providing oversight to ensure
authorizations for outpatient services or ancillary services in
preparation for the Member's discharge and ensuring that turnaround
times are effectively and efficiently met.12. Responsible for
providing oversight to ensure Members are referred to Health
Management, Health Education, Care Management, Transition of Care,
Behavioral Health, or other internal or external programs as
needed.13. Responsible for reviewing of Quality Assurance (QA)
results as reported by the QA/Training Department as well as QA of
Team Member cases as operations permit.14. Assist Inpatient Review
Nurse Manager by representing Inpatient Review Department in
selected IEHP meetings.15. Assist Inpatient Review Nurse Manager in
the orientation of new team members.16. Responsible for coaching,
evaluating and providing annual performance evaluation feedback to
Supervisory ResponsibilitiesLeader: Administers Hires,
Terminations, and Performance Reviews
Experience Qualifications Three years of Utilization
Management/Case Management in a health care delivery setting, with
an emphasis on Concurrent Review and utilization management, and
one-year supervisory experience
Education Qualifications High school diploma or GED required.
Professional Licenses Possession of an Active, unrestricted, and
unencumbered Registered Nurse (RN) license issued by the California
Drivers License RequiredYes, must have a valid California Driver's
Knowledge Requirement Responsible for the performance of concurrent
and retrospective reviews for medical necessity and appropriateness
of service and care. Knowledge of evidence-based clinical criteria
and California Children Services (CCS).
Skills Requirement Must have strong analytical skills, time
management, and problem solving skills. Excellent communication,
interpersonal and organizational skills.
Abilities Requirement Self-starter and a team player. Must have a
high degree of patience.
Commitment to Team Culture The IEHP Team environment requires a
Team Member to participate in the IEHP Team Culture. A Team Member
demonstrates support of the Culture by developing professional and
effective working relationships that include elements of respect
and cooperation with Team Members, Members and associates outside
of our organization. Starting Salary: $85,841.60 - $109,449.60
Inland Empire Health Plan (IEHP) is the largest not-for-profit
Medi-Cal and Medicare health plan in the Inland Empire. We are also
one of the largest employers in the region. With a provider network
of more than 6,000 and a team of more than 2,000 employees, IEHP
provides quality, accessible healthcare services to more than 1.2
million members. And our mission and core values help guide us in
the development of innovative programs and the creation of an award
winning workplace. As the healthcare landscape is transformed,
we're ready to make a difference today and in the years to come.
Join our Team and Make a Difference with us! IEHP offers a
Competitive salary and a benefit package with a value estimated at
35% of the annual salary, including medical, dental, vision, team
bonus, and retirement plan.
Keywords: IEHP, Rancho Cucamonga , Supervisor, Utilization Management Clinical, RN - Inpatient, Executive , Rancho Cucamonga, California
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