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Utilization Management & Complex Case Management Director (RN)

Company: Central California Alliance For Health
Location: Scotts Valley
Posted on: January 16, 2022

Job Description:

  • We have one position available and it can be filled in any of our offices: Salinas, Scotts Valley or Merced
    We have an opportunity to join the Alliance as the Utilization Management & Complex Case Management Director (RN).

    What You'll Be Responsible For

    This role provides strategic management oversight in implementing, directing and monitoring the Alliances Utilization Management and Complex Case Management Department functions; Directs the Utilization Management and Complex Case Management Department, acts as a subject matter expert, and provides executive level advice and guidance on the Departments functions and overall business operations; Directs, manages and supervises Utilization Management and Complex Case Management Department staff.

    What You'll Need To Be Successful

    To read the full position description, and list of requirements click here.
    • Knowledge of:
      • Principles and practices of utilization management and complex case management
      • Principles, practices, tools, and techniques used in clinical nursing
      • Medi-Cal, Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations
      • Principles and practices of managed care
      • Ability to:
        • Direct, manage, supervise, mentor, train and evaluate the work of staff
        • Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
        • Act as a technical resource and explain complex laws, regulations, processes, and programs related to area of responsibility
        • Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
        • Manage multiple projects simultaneously, organize work, and achieve goals and timelines
        • Foster effective working relationships, influence others and build consensus with individuals at all levels in the organization
        • Demonstrate a collaborative management style, build rapport, and effectively manage internal and external business relationships including members of the medical community, community agencies, and board members
        • Education and Experience:
          • Current unrestricted license as a Registered Nurse issued by the State of California
          • Bachelors degree in Nursing, Behavioral Health, Social Science or a related field and a minimum of ten years of utilization management experience which included a minimum of five years of experience in a managed care environment and three years of staff management experience (a Masters degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
            Other Details
            • While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely
            • This position may require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will most likely be on a part-time basis, but is dependent on business needs
              Additionally, all positions at the Alliance are required to meet these minimum qualifications.

              Our Benefits
              • Medical, Dental and Vision Plans
              • Ample Paid Time Off
              • 11 Paid Holidays per year
              • 401(a) Retirement Plan
              • 457 Deferred Compensation Plan
              • Robust Health and Wellness Program
              • EV Charging Stations
              • And many more
                About Us

                We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

                Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here.

                At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided Jobble

Keywords: Central California Alliance For Health, San Francisco , Utilization Management & Complex Case Management Director (RN), Healthcare , Scotts Valley, California

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