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Managed Care Clinical UM Quality Nurse Director

Company: Nurse Management
Location: San Francisco
Posted on: February 15, 2018

Job Description:

A leading managed care organization is looking for a Clinical Operations Director to join its Utilization Review and Quality Review teams.
The Nurse Director will be responsible for the day to day operations of the Utilization Review and Quality departments. The RN Director will have excellent understanding of all facets of the managed care operations and will facilitate communications between the health plan, the county and their network providers to include community agencies, acute care hospitals, skilled nursing facilities, CPHQs and physician run clinics.
The Nurse Director will demonstrate an in-depth knowledge of HIPAA compliance standards, HEDIS and all operations policies and procedures. The Regional Operations Director will facilitate the UM and Quality processes in addition to creating cohesive teams to achieve service excellence.
The RN Director will maintain a professional and productive working relationship with County Administrators and be accountable for budget performance related to cost compliance and containment. The UM and Quality Nurse Leader will work with leadership, Human Resources and others to address employee conflicts and disciplinary matters while working to maximize employee satisfaction for operations staff.
The Operations leader will be responsible with other operational leadership for base level employee satisfaction and turnover containment. The Nurse Director will streamline work flows and optimize efficiency and service.

Keywords: Nurse Management, San Francisco, Managed Care Clinical UM Quality Nurse Director, Executive, San Francisco, California

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