Utilization Management Supervisor- Concurrent Review RN

Profile

We have an opportunity to join the Alliance as a Utilization Management Supervisor- Concurrent Review (RN).

There is one position which can be filled in any of our offices (Salinas, Merced or Scotts Valley)

WHAT YOU'LL BE RESPONSIBLE FOR

In this role, you will supervise the Concurrent Review function, act as a subject matter expert and provide guidance on Concurrent Review processes and functions; Supervise, train and mentor assigned staff; perform duties as a UM Concurrent Review Nurse, as needed

ABOUT THE TEAM

​We review member care and services to validate the necessity and to explore alternatives to inpatient care. We also track the consumption of resources and the progress of members while being treated.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

Knowledge of:

The principles and practices of clinical nursing

The principles and practices of UM

The basic principles and practices of supervision and training

MCG

Medi-Cal and related policy and Title 22 regulations

Ability to:

Evaluate medical records and other health care data

Train, mentor, supervise and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives

Plan, organize and prioritize the work of others, delegate effectively, coordinate activities and projects, follow up on work assignments and adhere to timelines

Act as a technical resource and explain regulations, processes and programs related to area of assignment

Education and Experience:

Current unrestricted license as a Registered Nurse issued by the State of California

Associate’s degree in Nursing and a minimum of five years of clinical nursing experience which included at least one year of Utilization Management experience and some supervisory or team lead experience years (or a Bachelor’s degree and a minimum of two years); or a combination of education and relevant work experience may be qualifying

OTHER DETAILS

While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely

This position

may

require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will be dependent on business needs

Additionally, all positions at the Alliance are required to meet these minimum qualifications

OUR BENEFITS

Medical, Dental and Vision Plans

Ample Paid Time Off

11 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

EV Charging Stations

And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

Central California Alliance for Health
Website : http://www.ccah-alliance.org/