Registered Nurse (RN) – Manager Central UM, in Long Beach, CA (1288BR) Long Beach, California

 

Job Summary

Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.  Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and outcomes achieved by the team and recommends enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines in day-to-day activities.

Essential Functions• Oversees, coordinates and monitors all Care Access and Monitoring clinical and non clinical team activities to facilitate integrated proactive utilization management.
• Functions as hands-on manager for daily integrated Care Access and Monitoring activities.
• Manages and evaluates team members in the performance of various utilization management activities.
• Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long Term Care for Molina members.
• Ensures adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.
• Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
• Maintains effective team member relations.
• Conducts regular staff meetings (at least monthly).
• Assists with selection, orientation and mentoring of new team members.
• Conducts performance evaluations in a timely manner.
• Provides coaching, counseling and employee development and meets individually with staff at least monthly.
• Recognizes exceptional employee performance.
• Completes quality audit reviews for all clinical / non-clinical staff.
• Assists team members in improving skills, creativity and problem solving.
• Collaborates with and keeps the Manager of Healthcare Services appraised of operational issues, staffing, resources, system and program needs.
• Manages and completes assigned work plan objectives and projects on a timely basis.
• Participates in committees, task forces, work groups and multidisciplinary teams as needed.
• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement. 
• Oversees staff activities to ensure compliance with regulatory and accrediting standards.
• Creates and ensures timely and accurate reporting to Central AVP Clinical Programs.
• Conducts self in a professional manner at all times. 
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Acts as an information and problem solving resource for Care Access and Monitoring team member.
• Interacts with medical directors regularly, as necessary.
• Facilitates open and timely communication between team members, other Molina employees and external customers.
Complies with required workplace safety standards.

 

Knowledge/Skills/Abilities

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Skilled at supervising high functioning multidisciplinary teams.
• Able to use effective management principles.
• Excellent organizational skills with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• In depth knowledge of Interqual and other references for length of stay and medical necessity determinations
• Experience with NCQA.
• Knowledge of state/federal regulatory requirements.
• Ability to take initiative and see tasks to completion.
• Computer Literate (Microsoft Office Products).
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.



Required Education: 
Registered Nurse.  Bachelor’s degree in Nursing or related field required (equivalent combination of experience/education will be considered in lieu of Degree).
   
Required Experience:  
Three or more years of clinical nursing experience and two years or more utilization management experience; and at least one year of healthcare supervisory experience.
 
Required Licensure/Certification:
Active, unrestricted State Registered Nursing license in good standing.
 
Preferred Education:
Master’s degree in Nursing or related field.
Preferred Experience:
Three or more years in a supervisory role in a Managed Care Environment
 
Preferred Licensure/Certification:
Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification  
 



Molina Healthcare, a FORTUNE 500 company that is nationally recognized and has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Molina Healthcare is a multi-state healthcare organization with flexible care delivery systems focused exclusively on government-sponsored healthcare programs for low income families and individuals. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through MedicaidMedicare and other government funded programs in 15 states. We continually seek talented individuals who share our values and can contribute to our mission of providing the highest quality health care to those who need it most and are least able to afford it. Become part of the Molina Healthcare family today! Discover extraordinary opportunities for growth.

Molina Benefits

Molina offers a variety of career opportunities across the nation as well as excellent compensation and an attractive benefits package that includes.

  • Medical
  • Dental
  • Vision
  • Short- and long-term disability
  • Flexible spending accounts
  • Life insurance plans
  • 401(k) savings plan with employer match
  • Paid time off
  • Paid holidays
  • Volunteer time off
  • Tuition reimbursement
  • Referral bonuses and more!

 

Molina Healthcare is a Diverse Healthcare Atmosphere & Equal Opportunity Employer (EOE) M/F/D/V.

Job Key Words: RN, Nurse, Nursing, Registered Nurse, Utilization Management,NCQA,(CPHM), Certified Professional in Health Care Quality (CPHQ), Certified Case Manager. (CCM), Managed care, Medicaid/Medicare, Long Beach, CA

To apply, please click here