Supervisor, UM BH Clinical RN - Inpatient (Remote)

Date: Jan 14, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6682 

 

Position Summary/Position

 

Under the direction of the Inpatient Review Nurse Manager, the UM Clinical, RN- BH Supervisor will oversee Inpatient BH 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. The Supervisor is responsible for overseeing daily operations of clinical care management, coordination of care, and continuity of care for IEHP members with, or at risk for, mental health, behavioral health.

Major Functions (Duties and Responsibilities)

 

1. Responsible for the oversight of Inpatient BH Review and collaborative interactions with the other departments within IEHP and external partners. 
2. Provide leadership and supervision of day-to-day inpatient BH 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 BH 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. Responsible for providing oversight of concurrent and retrospective reviews for medical necessity per evidence-based criteria, appropriateness of service and level of care.
8. 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.
9. Responsible for providing oversight to ensure Members are referred to Health Management, Health Education, Care Management, Transition of Care, or other internal or external programs as needed.
10. 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.
11. Assist Inpatient Review Nurse Manager by representing Inpatient BH Review Department in selected IEHP meetings.
12. Assist Inpatient Review Nurse Manager in the orientation of new team members.
13. Responsible for coaching, evaluating, and providing annual performance evaluation feedback to Team Members.
14. Proactively recognize problematic or risk areas and help develop effective and efficient solutions and provide clinical supervision as necessary, consulting on high-risk cases and providing direction to BH inpatient team.
15. Collaborates with BH & CM providers, IEHP Members and other departments regarding BH concerns
16. Provide clinical supervision as necessary, consulting on high-risk cases and providing direction to BH & CM Department
17. Participate in LEAN activities.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

A total of three (3) years of experience: One (1) year of experience in a supervisory or lead capacity. Two (2) years or more of UM/ CM experience in a behavioral health care setting with an emphasis on concurrent review and utilization management. 

Preferred Experience

Education Qualifications

 

Associate’s degree in the field of Nursing from an accredited institution required.

Preferred Education

Professional Certification

Professional Licenses

 

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Knowledge of community resources and ability to make recommendations about the best course of action. Knowledge of health plan benefits in order to make referrals to other agencies when needed. Clinical knowledge of how mental disorders and psychosocial stressors can impact health conditions. Provide Clinical guidelines for Care Managers regarding psychiatric medication treatment issues and demonstrate expertise in the treatment of severe and persistent mental illness.

Skills Requirement

 

Clinical assessment skills to review treatment plans and clinical information in order to make appropriate referrals for treatment. Effective Communicator. Critical Thinking Skills.

Abilities Requirement

 

Active Collaborator.

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.

Working Conditions

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Lighting - CONSTANTLY

 

Starting Salary: $85,841.60  - $109,449.60  

Pay rate will commensurate with experience

 

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.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles