Complex Case Management Supervisor - Pediatric RN

Profile

We have an opportunity to join the Alliance as a Complex Case Management Supervisor - Pediatric (RN) in the Utilization Management and Complex Case Management Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Complex Case Management Manager - Pediatric (RN), you will supervise a team, including ensuring effective and efficient coordination and implementation of care coordination programs and processes. You will supervise, mentor, and train assigned staff. You will support Utilization Management (UM) and Prior Authorization processes.

WHAT YOU'LL NEED TO BE SUCCESSFUL

Knowledge of:

CCS and the regulatory requirements related to CCS and the WCM program

The principles and practices of managed health care and health care systems

The principles and practices of utilization management and care management

The diverse needs of the Medi-Cal population

The basic principles and practices of supervision and training

Ability to:

Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives

Develop work plans and workflows and organize and prioritize Until activities

Plan, organize and prioritize the work of others, delegate effectively, coordinate activities and projects, follow up on work assignments, and adhere to timelines

Education and Experience:

Current unrestricted license as a Registered Nurse (RN) issued by the State of California

Bachelor’s degree in Healthcare, Social Science, Business or a related field and a minimum of five years (or a Master’s degree and three years) of experience in the healthcare field, including a minimum of three years of experience performing work as an RN in a patient care setting, a minimum of two years of experience working with the pediatric population to identify appropriate diagnoses and ensure access to CCS and other applicable services, some utilization management or case management experience, and some lead or supervisory 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 hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.

Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.

Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

COVID-19 Vaccine Requirement:

This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.

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 members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet

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 sponsorship.

Company info

Central California Alliance for Health
Website : http://www.ccah-alliance.org/