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Health Services Clinical Manager

Yoh Goleta, CA Full-Time
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Health Services Clinical Manager, Registered Nurse needed for a full-time, direct hire opportunity with Yoh's client located in Santa Barbara, CA.

Position Overview: The Health Services Clinical Manager is a Registered Nurse who plans, organizes, and manages the daily operations of a designated unit within the Health Services Department. This position provides leadership, direction, and support for one of the following units: Utilization Management or Case Management. The Health Services’ Utilization or Case Management department primarily comprises of licensed registered nurses, Masters’ prepared social workers and clinical psychologists

Top Skills You Should Possess:

  • Active/unrestricted Registered Nurse license in state of California
  • Bachelor’s degree required. Bachelor in Nursing preferred
  • Minimum of two – three (2-3) years of experience in supervisory position

What You'll Be Doing:

  • Plan, develop, and oversee either UM or CM activities as assigned
  • Participate in the development and implementation of effective and efficient standards, policies, protocols, processes and reports
  • Participate in internal and external audits
  • Analyze and prepare periodic reports of either UM or CM activities as assigned
  • Evaluate effectiveness of health plan-wide UM or CM activities
  • Identify and address process issues related to UM or CM activities and functionality
  • Act at the subject matter expertise in UM or CM related activities
  • Collaborate with IT in the development of electronic health records, functionality, and reports
  • Provide guidance to providers and members related to timely request, authorization requirement, etc.
  • Act as the liaison to provider
  • Provide clinical input for projects and programs within the Health Services Department.
  • Ensure Unit meet departmental, regulatory, and contractual compliance goals.
  • Act as a liaison to internal and external customers for prompt resolution of issues
  • Monitor staff productivity and compliance
  • Serve on agency committees
  • When assigned to UM:
    • Assist with claims review as assigned
    • Measure and report consistency in applying UM criteria (interrater reliability)

What You Need to Bring to the Table:

  • Knowledge of current principles and practice of managed care and health plan regulatory requirements
  • Ability to plan, direct, and coordinate activities for a large number of subordinates
  • Take a leadership role to initiate activities, communication and projects
  • Experience working with Medi-Cal patients
  • Knowledge of InterQual or MCG clinical guidelines

What's In It For You?

  • Competitive pay with opportunities for advancement
  • Stable, long-term company that offers a pension plan, professional development and wellness benefits, alternative transportation incentives, and comprehensive medical, dental, vision, and life insurance

*Ask me about our REFERRAL BONUS program!*

We have multiple openings so help us spread the word!

Recruiter: Marine Kokoshyan

Phone: [ Phone number blocked ] - Click here to apply to Health Services Clinical Manager

Email: [ Email address blocked ] - Click here to apply to Health Services Clinical Manager 

 

Recommended skills

Utilization Management
Managed Care
Claims
Auditing
Authorization (Medical)
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Job ID: BHJOB18230_242754

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