Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low‑income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low‑income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Supervisor of Utilization Management (UM) RN is responsible for executing the day‑to‑day operations of the UM department and monitoring the Care Management (CM) staff’s responsibilities and activities. This includes, but is not limited to, ensuring proper staffing and coverage; monitoring and evaluating departmental operations to ensure optimal efficiency, productivity, and effectiveness; documenting and appropriately addressing excellence or deviations in work, departmental, and organizational expectations; and conducting intermittent and annual performance evaluations. The Supervisor assists in triaging identified issues/problems and forming resolution within the scope of work/licensure. The Supervisor is a subject matter expert (SME) in Care/Case/Utilization Management and supporting regulations, policies, protocols, and procedures. This position serves as a formal and informal instructor, escalates issues/concerns to the appropriate person when outside of their scope.
The Supervisor ensures all functions of the UM department are operating in accordance with the organization’s mission, values and strategic goals, which are focused on quality care delivery and continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care’s culturally diverse membership.
Duties
Ensures adequate/appropriate distributions of workforce, assignments and time off requests. Participates in the hiring and termination process providing recommendations with appropriate supporting documentation.
Monitors staff performance including productivity and compliance with regulatory requirements, compliance with policies. Identifies, communicates and coaches to improve staff performance. Develops tools, job aids, and workflows to optimize the process flow, performance and productivity of the UM team. Completes intermittent and annual staff evaluations.
Serves as the primary resource for all business‑related questions/issues raised by staff; escalates to appropriate leader/team when necessary.
Recommends and implements process improvement measures to achieve department’s performance measures outcomes and goals.
Plans and oversees UM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members.
Maintains all assigned reporting responsibilities, conducts regular audits to ensure compliance with community, industry and organizational standards including regulatory requirements. Serves as a super‑user on electronic programs and systems used by the department.
Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklist necessary to meet educational needs. Trains new staff, remediation of seasoned staff and cross training as needed in specified business lines.
Serves as a leader and role model as well as technical and informational resource for staff and peers.
Fosters a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes.
Services as member/resource/liaison to the Interdisciplinary Care Team.
Recommends resources to improve performance standards in terms of Utilization Management. Collaborates with peers and colleagues within the organization to address process improvements, member’s needs, department and organizational enhancements and communicate development as appropriate.
Participates on internal and external committees as delegated or assigned.
Serves as a consultant to other departments or organizations as needed.
Responsible for the daily workflow and leading the work of assigned staff. This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.
Performs other duties as assigned.
Education Required
Associate’s Degree in Nursing
Education Preferred
Bachelor’s Degree in Nursing
Experience Required
Minimum of 7 Years of Acute/Clinical Care Experience.
Minimum of 2 years of experience in Case/Care/Utilization Management in an acute care or health plan setting.
Minimum of 3 years leading process, program, or staff or supervisory experience.
Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Skills Required
Knowledge of state, federal and regulatory requirements in Care/Case/Utilization Management.
Strong verbal and written communication skills.
Computer literacy with proficiency with Microsoft Word, Excel, etc. and ability to learn core departmental computer systems and software.
Excellent organizational, time management, and interpersonal skills.
Must be detailed‑oriented, energetic, and an enthusiastic team player.
Must be able to work independently.
Licenses/Certifications Required
Registered Nurse (RN) – Active, current and unrestricted California License
Physical Requirements
Light
Salary Range Disclaimer
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Equal Employment Opportunity Statement
L.A. Care Health Plan is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, color, religion, sex, national origin, disability, veteran status or any other protected status.