Supervisor, UM Clinical RN - Specialty (Remote)

Date: Jul 27, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7652 

 

Position Summary/Position

 

Under the direction of the UM Long Term Care Manager, the UM Clinical, RN Specialty Teams Supervisor will oversee Specialty Team 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.

Major Functions (Duties and Responsibilities)

 

1. Responsible for the oversight of Specialty review and care coordination and collaborative interactions with the other departments within IEHP and external partners.
2. Provide leadership and supervision of day-to-day Specialty Team 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 Specialty 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 Specialty Team 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. Accountable for the promotion of continued professional growth, training and education of self and team members as evidenced by attendance at leadership trainings, CEU events, etc.
8. Assist with identifying network opportunities based on vendor and specialty gaps and work with UM management, Provider Relations, and  the  Contracts  Departments  to  ensure  an  extensive network exists at all times.
9. Assist with planning, development, and implementation of new UM software.
10. Responsible for providing oversight of specialty (transplant, ESRD, COC repatriation) and retrospective reviews for medical necessity per evidence-based criteria, appropriateness of service and level of care.
11. Responsible for providing oversight to ensure authorizations for transplant, ESRD, and COC repatriation services including ancillary services in preparation for the Member’s transplant procedures and discharge needs and ensuring that turnaround times are effectively and efficiently met.
12. Responsible for providing oversight to ensure Members are referred to Health Management, Health Education, Care Management, Transition of Care, Behavioral Health, or other internal or external programs as needed.
13. 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. 
14. Assist UM Manager by representing the Specialty Team Department in selected IEHP meetings.
15. Assist UM Manager in the orientation of new team members.
16. Responsible for coaching, evaluating and providing annual performance evaluation feedback toTeam Members.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Three (3) years of Utilization Management/Case Management in a health care delivery setting, with an emphasis on utilization management, and one (1) year of Lead/Supervisory capacity experience.

Preferred Experience

Education Qualifications

 

High School Diploma or GED 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

No

Knowledge Requirement

 

Responsible for the performance of pre-service for specialty area and retrospective reviews for medical necessity and appropriateness of service and care. Knowledge of evidence-based clinical criteria and California Children Services (CCS).

Skills Requirement

 

Must have strong analytical skills, time management, and problem-solving skills.  Excellent communication, interpersonal and organizational skills.

Abilities Requirement

 

Self-starter and a team player. Must have a high degree of patience.

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

 

While performing the duties of this job, the team member is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The team member must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Work Model Location

Physical Requirements

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

 

Starting Salary: $91,000.00  - $116,022.40  

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 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and 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 state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles