Supervisor, Utilization Management RN

Salary Range

Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)

About the role

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, we make sure our members get the right care at the right place at the right time.

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.

Responsibilities

• Ensures adequate/appropriate distributions of workforce, assignments and time off requests.
• Participates in the hiring and termination process providing recommendations with appropriate supporting documentation.
• Makes sure 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.
• Aids 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.
• Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes.
• Serves 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 communicates development as appropriate.
• Participates on internal and external committees as delegated or assigned.
• Serves as a consultant to other departments or organizations as needed.
• Responsible for the daily workflow and leading the work of assigned staff.
• This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.

Requirements

• Minimum Of 7 Years Of Acute/clinical Care Experience.
• Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting.
• Minimum of 3 years leading process, program, or staff or supervisory experience.

Qualifications

• Associate's Degree in Nursing Education Preferred.
• Bachelor's Degree in Nursing.

Skills

• 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

• Registered Nurse (RN) - Active, current and unrestricted California License.