Job Description

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 within 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 when outside 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 achieve the department's overall performance metrics. The Supervisor ensures all 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 continuous improvement; and are provided in a manner that is responsive and sensitive to the n…

Qualifications

Education Required:

• Associate's Degree in Nursing

Education Preferred:

• Bachelor's Degree in Nursing

Experience Required:

• Minimum of 7 years of acute/clinical care experience. 
• Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting. 
• Minimum of 3 years leading process, program, or staff or supervisory experience. 
• Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

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 Microsoft Word, Excel, 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, current and unrestricted California License

About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.