Providence Health & Services RN - Supervisor - UM Ambulatory Case Management in Mission Hills, California
Providence is calling a to our Facey Supervisor - RN UM Ambulatory Case Management to our Facey Case Management location in Mission Hills, CA.
In this position you will:
Works with the UM Manager to develop, coordinate and supervise operational activities that are directly associated with Utilization Management of the medical services provided to Facey HMO patients.
Is a resource to the ambulatory nurses ensuring that appropriate guidelines and criteria are used and that cases are appropriately evaluated by the UM Medical Director.
Works with the UM Manager to monitor denial accuracy, denial timeliness, productivity of each UM Ambulatory Case Manager, completion of documentation to support decision in IDX including guidelines and references cited.
Works with UM Ambulatory Nurse Case Managers to develop and maintain constructive working relationships with providers, health plans and regulatory agencies.
Works with staff to treat each other with respect and professionalism as defined in our guiding Mission and Values.
Required qualifications for this position include:
RN graduate of an accredited school of nursing, 3 - 5 years experience in a managed care setting/utilization review/discharge planning/case management of which 2 years is in hospital or ambulatory case management.
Current California RN license.
American Heart Association BLS for Health Care Providers required.
Must possess excellent customer service and communication skills.
Must be organized and a self‑starter. Must have extensive knowledge of health plan requirements and benefits as applied to the utilization and case management process.
Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software.
Needs to be able to access and use all clinical guidelines approved by UM Committee for use including: Milliman, Up to Date, American College of Cardiology, and health plan guidelines.
Needs to be aware of Health Plan criteria regarding timeliness of referrals, denial rationale and denial language.
Must possess strong oral and written communication skills, problem solving and analytical skills as related to Utilization Management.
Preferred qualifications for this position include:
Bachelor’s degree preferred.
2 years of supervisory experience is preferred.
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Location: California-Mission Hills
Req ID: 190086