Manager of Clinical Services, RN - AppleCare Medical - La Palma, CA - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.The Manager of Clinical Services is responsible for the supervision of Complex Case Managers and Case Management Assistants including, but not limited to, direct supervision, counseling and corrective actions, education, training, and audits. Provides daily operational direction to the Inpatient Services Department including oversight and supervision of Inpatient Case Managers. Works collaboratively with the Medical Director for Inpatient Services and Acute and Post - Acute Services to ensure patients are cared for at the correct facility according to risk arrangement. Administers responsibilities in accordance with AppleCare and department policies and procedures, and applicable laws. Responsibilities include interviewing, hiring and training employees, addressing complaints and conflict resolution.Primary Responsibilities:Provides direct day to day supervision of staff including licensed and unlicensed staffPreparation for case review meetings including health plan specific reviews as directed by Director of IP ManagementAcute and SNF Inpatient management (reviews, denials, transfers)Oversight of discharge planningWorks directly with hospitalists to facilitate appropriate length of stay and resolution of specialist issuesProvide ongoing educational opportunities to staff, ensuring an understanding of the business processes, technology used within the organization, regulatory compliance, program standards and outcomesPreparation of inpatient denial letters including DENC as requiredAssists with health plan audits and surveysDevelops and implements new policies and proceduresOrients / trains case management staff on case management processes and identifies efficiencies and develops / facilitates corrective action plansParticipates in IPA UMC Meetings and Provider Office Meetings as assigned
Required Qualifications:Current unrestricted RN licensure in the state of CA3 or more years of management experience2+ years of experience in Managed CareKnowledge of Case Management, Utilization Management and Quality Management processes and principlesKnowledge of and experience with medical codingKnowledge of general IPA operationsComputer literate in Microsoft Word and ExcelPreferred Qualifications:Complex Case management experienceCCM - Professional Certification or LicenseCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world s large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life s best work.(sm)Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: Complex Case Manager, RN Case Manager, RN, La Palma, CA
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