Providence Health & Services RN - Supervisor - UM Hospital Nurse Case Management in Mission Hills, California

Description:

Providence is calling a RN - UM Hospital Nurse Case Management Supervisor ( Full Time / Day Shift ) to our Facey Medical Foundation Case Management Department location in Mission Hills, CA.

In this position you will:

  • Works with the Case Management Director to develop, coordinate and supervise operational activities of the UM Hospital Nurse Case Managers providing case management services to Facey HMO inpatients.

  • Is a resource to the hospital nurse case managers ensuring that appropriate guidelines and criteria are used, discharge planning checklists are employed, Allscripts CM Assessment , daily and discharge notes are completed and electronically saved, and patients are moved appropriately through the continuum of care with consistent communication across FMG Hospitalist and PCP team, and directly to patients and caregivers.

  • Works with the Case Management Director to develop and maintain constructive working relationships with FMF and Hospital staff, providers, health plans and regulatory agencies.

Qualifications:

Required qualifications for this position include:

  • RN graduate of an accredited school of nursing.

  • Three to five years experience in a managed care setting/utilization review/discharge planning/case management of which two years is in hospital or ambulatory case management.

  • Current California RN license

  • American Heart Association BLS for Health Care Providers.

  • 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 and multiple EHR systems software.

  • Needs to be able to access and use all clinical guidelines approved by UM Committee for use including: Milliman, Up to Date 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.

  • Is aware and able to approach patients and caregivers to discuss end of life issues and document wishes when communicated.

  • Understands POLST and AD processes.

Preferred qualifications for this position include:

  • 2 years of supervisory experience.

  • Bachelor’s degree.

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, San Gabriel 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

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

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.

About Us

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.

Schedule: Full-time

Shift: Day

Job Category: Non-Clinical Lead/Supervisor/Manager

Location: California-Mission Hills

Req ID: 210908