Utilization Management RN Supervisor (Remote)

Medica Talent group is excited to bring this direct hire opportunity with a leading managed care organization in the Los Angeles Area. The position is 100% remote and works PST hours. RN CA License required. • *out of state applicants may apply** Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: Minimum of 5-7 years of acute/clinical care experience. Minimum of 2 years' experience in Case/Care/Utilization Management in an acute care or health plan setting. Minimum of 3-4 years in a reputed company/supervisory experience. Skills Required: Knowledge of state, federal and regulatory requirements in Care/Case/Utilization Management. Strong verbal and written communication skills. Computer literacy with proficiency with reputed company Word, reputed company, 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. Licenses/Certifications Required Registered Nurse (RN) - Active, reputed company and unrestricted California License Certified Case Manager (CCM)Licenses/Certifications Preferred Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the Care Management (CM) staff’s responsibilities and activities. This includes, but not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. This role assists in triaging identified issues/problems and forming resolution reputed company the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Care/Case/Utilization Management and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, and escalates issues/concerns to the appropriate person reputed company reputed company of their scope. This position is responsible in assisting with and development and maintenance of a successful and cohesive unit, with high level of productivity and accuracy to reputed company the department's overall performance metrics. The Supervisor ensures reputed company functions of the UM department are operating in accordance with the organization's mission, values and strategic goals, which are focused on quality care delivery and reputed company improvement; and are provided in a manner that is reputed company and sensitive to the needs of LA Care's culturally diverse membership. The position supports the UM Manager/Director. This role also assists UM Educator/Manager/Director in identification of training needs including, but not limited to, collaborating in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of UM staff. The position supervises reputed company aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. Duties 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 of staff's performance including productivity and compliance with regulatory requirements, compliance with policies. Identifies, communicates and coaches to improve staff performance. Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the UM team. Completes intermittent and annual staff evaluations. Serves as the primary resource for reputed company business-reputed company questions/issues raised by staff; escalates to appropriate leader/team reputed company necessary. Recommends and implements process improvement measures to reputed company 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 reputed company 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, 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. Duties reputed company Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes. Services 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 reputed company 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. Performs other duties as assigned. The Company offers a wide range of benefits including • Paid Time Off (PTO) • Tuition Reimbursement • Retirement Plans • Medical, Dental and Vision • Wellness Program • Volunteer Time Off (VTO) Job Type: Full-time Pay: $115,000.00 - $135,000.00 per year Benefits: • 401(k) • Dental insurance • Health insurance • Life insurance • Paid sick time • Paid time off • Vision insurance Education: • Associate (Required) Experience: • managed care: 4 years (Preferred) • Utilization management: 5 years (Preferred) • acute inpatient reputed company review and discharge planning: 2 years (Required) Language: • Spanish/ Mandarin/ another language (Preferred) License/Certification: • California RN License (Required) • Certified Case Manager (Preferred) Work Location: Remote Apply Job!