Lvn Supervisor Um Prior Auth

Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California.  Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service.

***Please note:  This position will be work from home within the Sacramento, CA region.

Position Summary:

Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promotes the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care Prior Authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines.

Minimum Qualifications:

- Five or more (5+) year's clinical experience required.
- Three to five (3-5) years Utilization Management experience required.
- One to three (1-3) years charge/lead/supervisory/management experience required.
- Ability to demonstrate leadership and management skills.
- Graduate of an accredited school of nursing.
- Clear and current CA Licensed Vocational Nurse (LVN) license.
- Special Skills:
Knowledge of all applicable federal and state regulations as well as accreditation standards. Demonstrates a working knowledge of Utilization Management Working knowledge of the Utilization Management review processes, and regulatory requirements. Must have the ability to monitor, compile, report and analyze data/statistics. Requires excellent human relations, interpersonal and oral/written communication skills. Demonstrated ability to lead and development staff members. Able to recognize and address the needs and concerns of customers. Ability to interact with all levels of the organization as well as with external contacts. Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications.

Preferred Qualifications:

- 7 years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred.
- Experience working with health plan auditors preferred.
- Bachelors of Science in Nursing and/or Master's level degree preferred
- Working knowledge of InterQual preferred.
- Knowledgeable of NCQA and ICE preferred.