Supervisor, Utilization Management RN

Location: Los Angeles, 90017

About the role

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 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. 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.

Responsibilities

• Oversee day-to-day operations of the Utilization Management (UM) department.
• Monitor and evaluate Care Management (CM) staff’s responsibilities and activities.
• Ensure proper staffing and coverage within the department.
• Document and address excellence or deviations in work, departmental, and organizational expectations.
• Conduct intermittent and annual performance evaluations.
• Triage identified issues/problems and form resolutions within the scope of work/licensure.
• Serve as a subject matter expert (SME) in Care/Case/Utilization Management and related regulations, policies, protocols, and procedures.
• Act as a formal and informal instructor for staff.
• Escalate issues/concerns to appropriate personnel when outside of scope.
• Assist in the development and maintenance of a cohesive unit with high productivity and accuracy to meet departmental performance metrics.
• Ensure all UM department functions align with the organization's mission, values, and strategic goals focused on quality care delivery and continuous improvement.

Requirements

• Associate's Degree in Nursing (required).
• Bachelor's Degree in Nursing (preferred).
• 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.
• Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

About the organization

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Benefits

• Great compensation and benefits.
• Supportive management team.
• Opportunity for career growth.
• Camaraderie and a true sense of mission.

Pay

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

Schedule

Full Time