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Supervisor, Utilization Management Clinical, RN - Inpatient

Company: IEHP
Location: Rancho Cucamonga
Posted on: April 4, 2021

Job Description:

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 Team Members.
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 BRN
Drivers License RequiredYes, must have a valid California Driver's License.
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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