Outpatient Nurse Supervisor - Partnership HealthPlan of California
Fairfield, CA 94534
About the Job
Provide supervisory oversight during the daily operations of the outpatient review process. Supervise and train assigned team members. Provide leadership, support, resources, and direction to staff. Assist in determining appropriateness, quality, and medical necessity of requested service.
Responsibilities:- Supervises the assigned team, overseeing daily operation of the outpatient review process.
- Provides leadership, direction, resources, training, and support as necessary.
- Provides performance feedback to the assigned UM staff and conduct staff trainings as needed.
- Participates in the interview process of new hires.
- With UM Team Manager, conducts annual performance evaluations for assigned UM staff.
- Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC CMS regulatory requirements, PHC policies and procedures, and InterQual® for each product line.
- Documents and maintains patient-specific records in the PHC computer system, Essette, and in databases and files as applicable.
- Assists in the refinement/improvement of the Health Services programs. Participates in continuous process improvement endeavors.
- Works with other PHC departments to resolve issues relating to authorization of medical services.
- Audits medical records as appropriate.
- This position, in addition to his or her own case load, may be assigned cases in the area of oversight as deemed necessary to provide coverage.
- Communicates regularly with Team Manager/UM and works collaboratively to resolve personnel and workflow issues.
- Seeks manager assistance as needed while coordinating work, making decisions, and handling questions or problems.
- Participates in special projects and assignments as required.
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All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
HIRING RANGE:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational
factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other