Supervisor, UM Clinical, RN LTC/Post Acute

Position Summary/Position

Under the direction of the Manager, Long-Term Care (LTC), he/she will oversee the LTC clinical RN and non-clinical Team Members and work with skilled nursing facilities and IPAs to ensure coordinated and continuous cost-effective quality healthcare for IEHP Members at both the skilled and custodial level of care.

Major Functions (Duties and Responsibilities)

1. Work closely with the LTC Manager to coordinate daily staffing and coverage of the LTC unit.
2. Responsible for the oversight of long term care case review and retrospective reviews for medical necessity, appropriateness of service and level of care for skilled nursing and acute rehab levels of care.
3. Work closely with LTC Team Members to ensure authorizations for outpatient services or ancillary services are in place in preparation for the Member’s discharge or transition to lower level or higher level of care.
4. Responsible for ensuring that the concurrent or discharge review process includes referring Members to appropriate programs (e.g. Health Management, Health Education, Behavioral Health, Transitions of Care (TOC),  Care Management, etc.), as needed.
5. Responsible for ensuring that the concurrent or retrospective review Team Members are referring cases that require physician review to the Medical Director in a timely manner.
5. Responsible for ensuring timely compliance and completion of documents as required by all regulatory agencies, such as,  IFT Form, NOMNC, DND, DENC.
6. Responsible for providing information and assistance to skilled  LTC Team Members, other departments, IPAs and the skilled nursing facilities to support the goals of the department and the vision of the organization.
7. Represent the LTC department in selected IEHP meetings.
8. Assist in the orientation of new skilled team members.
9. Assist in the collection and analyzing of data for monthly reports.
10. Responsible for the Long Term Care Daily Census report.
11. Conduct Team Member coaching/counseling corrective action meetings with the assistance of a Human Resource representative and the LTC Manager, up to and including termination.
12. Coach, evaluate and provide annual performance evaluation feedback to skilled team members Team Members.
 

Supervisory Responsibilities

Limited Supervisor: Recommends Hires, Terms, and Performance Reviews

Experience Qualifications

Three (3) or more years of utilization management/case management in a health care delivery setting, with an emphasis on long term care and utilization management and one-year supervisory experience.

Education Qualifications

Possession of a valid RN license issued by the State of California. Bachelor’s degree preferred. Possession of a valid State of California driver's license automobile insurance

Professional Licenses

Possession of a valid RN license issued by the State of California.

Knowledge Requirement

Self-starter and a team player. Responsible for the oversight of long term care case review and retrospective reviews for medical necessity and appropriateness of service and care. Knowledge of evidence based clinically criteria and CMS, NCQA, local and national coverage determinations.

Other Characteristics

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.