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Health Services Clinical Supervisor, Santa Barbara, CA


Organization: CenCal Health
Category: Supervisor
Location: Santa Barbara, CA
Date Job Posted: July 10, 2020
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Health Services Clinical Supervisor

Clinical or Medical PEDIA01062
Full-Time
Santa Barbara, CA, USA

Job Details

Description

  • Provide education and training to health services clinical and administrative staff
  • Serve as a resource for other CenCal Health staff
  • Identify areas for process improvements and assists with their implementation
  • Support administrative and clinical staff in answering phone inquiries
  • As assigned, perform retrospective claims review
  • Carry a daily caseload of utilization or case management activities as assigned; supports clinical staff with day-to-day activities related to the review, coordination, care planning, and transition of care
  • Interface with and serve as a resource to members and providers to clarify processes, answer questions, and address issues or concerns
  • Handle and resolve daily issues, concerns and disputes of unit staff
  • Provide new staff orientation and mentor activities
  • Assist and coordinate staff assignments and coverages
  • Identify problems or issues within established utilization management (UM) or case management (CM) processes, policies or procedures, and make suggestions for efficient resolution
  • Identify process-oriented opportunities for improvement
  • Assist with coordination and facilitation of regular staff meetings
  • Participate in internal and external audits
  • Supervise staff
  • Other duties as assigned

Qualifications

Education

Preferred

  • Bachelors or better in Nursing or related field.

Experience

Preferred

  • 1-2 years: Experience in Medi-Cal and Medicare managed care health plan • Knowledge of managed care terminology, issues, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities • Knowledge of CCS eligibility concepts and case management processes • Knowledge of Medi-Cal guidelines, regulations and benefit limitations • Ability to clearly and effectively communicate verbally and in writing with providers, hospital staff and other health care providers • Depending on unit assignment, knowledge of current UM and CM scope and standards of practice and related productivity expectations and goals

Licenses & Certifications

Preferred

  • Registered Nurse

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