Utilization Management Supervisor- Concurrent Review (RN)

Company: Central California Alliance for Health
Location: Santa Cruz
Posted on: January 12, 2022

Job Description:

We have an opportunity to join the Alliance as a Utilization Management Supervisor- Concurrent Review (RN).
There is one position which can be filled in any of our offices (Salinas, Merced or Scotts Valley)

WHAT YOU'LL BE RESPONSIBLE FOR
In this role, you will supervise the Concurrent Review function, act as a subject matter expert and provide guidance on Concurrent Review processes and functions; Supervise, train and mentor assigned staff; perform duties as a UM Concurrent Review Nurse, as needed.

ABOUT THE TEAM
---We review member care and services to validate the necessity and to explore alternatives to inpatient care. We also track the consumption of resources and the progress of members while being treated.

WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements please visit our website.
Knowledge of:
The principles and practices of clinical nursing
The principles and practices of UM
The basic principles and practices of supervision and training
MCG
Medi-Cal and related policy and Title 22 regulations
Ability to:
Evaluate medical records and other health care data
Train, mentor, supervise and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
Plan, organize and prioritize the work of others, delegate effectively, coordinate activities and projects, follow up on work assignments and adhere to timelines
Act as a technical resource and explain regulations, processes and programs related to area of assignment
Education and Experience:
Current unrestricted license as a Registered Nurse issued by the State of California
Associate's degree in Nursing and a minimum of five years of clinical nursing experience which included at least one year of Utilization Management experience and some supervisory or team lead experience years (or a Bachelor's degree and a minimum of two years); or a combination of education and relevant work experience may be qualifying

OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely
This position may require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will be dependent on business needs

Keywords: Central California Alliance for Health, Santa Cruz , Utilization Management Supervisor- Concurrent Review (RN), Executive , Santa Cruz, California