Health Services Clinical Manager in Santa Barbara, CA at Volt

Date Posted: 5/7/2018

Job Snapshot

Job Description

Health Services Clinical Manager

We have an excellent opportunity is with an amazing company in beautiful Santa Barbara for a Health Services Clinical Manager. Must be a Registered Nurse who plans, organizes, and manages the daily operations of a designated unit within the Health Services Department. This position provides leadership, direction, and support for one of the following units: Utilization Management or Case Management. The position maintains up-to-date program descriptions, policies and procedure; participates in special assignments, audits, and focus projects; and performs related work as assigned. The Health Services’ Utilization or Case Management department primarily comprises of licensed registered nurses, Masters’ prepared social workers and clinical psychologists.

Duties and Responsibilities

  • Plan, develop, and oversee either UM or CM activities as assigned
  • Participate in the development and implementation of effective and efficient standards, policies, protocols, processes and reports
  • Participate in internal and external audits
  • Analyze and prepare periodic reports of either UM or CM activities as assigned
  • Evaluate effectiveness of health plan-wide UM or CM activities
  • Identify and address process issues related to UM or CM activities and functionality
  • Act at the subject matter expertise in UM or CM related activities
  • Collaborate with IT in the development of electronic health records, functionality, and reports
  • Provide guidance to providers and members related to timely request, authorization requirement, etc.
  • Act as the liaison to provider
  • Provide clinical input for projects and programs within the Health Services Department.
  • Ensure Unit meet departmental, regulatory, and contractual compliance goals.
  • Act as a liaison to internal and external customers for prompt resolution of issues
  • Monitor staff productivity and compliance
  • Serve on agency committees
  • Other duties as assigned
  • When assigned to UM:
    • Assist with claims review as assigned
    • Measure and report consistency in applying UM criteria (interrater reliability)