Supervisor, Utilization Management RN (Outpatient)

About the role

L.A. Care Health Plan, the nation's largest publicly operated health plan, is seeking a Supervisor of Utilization Management (UM) RN. This role is responsible for executing the day-to-day operations of the UM department and monitoring Care Management staff activities, including ensuring proper staffing and coverage, monitoring departmental operations for efficiency and effectiveness, documenting performance, and conducting performance evaluations. The Supervisor serves as a subject matter expert in Care/Case/Utilization Management, assists in triaging issues, serves as an instructor, and escalates concerns outside their scope. This position supports the UM Manager/Director and assists in identifying training needs, collaborating on program development, and supervising all aspects of team management including hiring, coaching, and motivating direct-reports.

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
• Monitors staff's performance including productivity and compliance with regulatory requirements and policies
• Identifies, communicates and coaches to improve staff performance
• Develops tools, job aids, and workflows to optimize 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
• Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs
• Trains new staff, provides 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 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 communicate 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
• Mentors, coaches, acts as a resource and provides feedback on performance of assigned staff
• Performs other duties as assigned

Requirements

• Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred
• Minimum of 7 years of acute/clinical care experience required
• Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting required
• Minimum of 3 years leading process, program, or staff or supervisory experience required (Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement)
• Registered Nurse (RN) - Active, current and unrestricted California License required

Qualifications & 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

Pay

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

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)