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The Manager of Medical Management is responsible for the overall day-to-day operations of the staff and activities requiring clinical licensure in the Utilization Management (UM) department. This position will work closely leaders to develop and organize the department's work priorities and deliverables. This position will manage clinical personnel to orchestrate and oversee the completion of tasks requiring clinical determinations. This position will also be responsible for internal and external reporting, and managing the monthly data needed to ensure department metrics are met or exceeded, including but not limited to, productivity, and satisfaction of internal and external customers. The Manager of Medical Management will also work closely with other LA Care Leaders to ensure that work is being completed accurately and timely. This position will collaborate with interfacing departments to ensure that consistent application of clinical criteria, quality of work, and productivity is maximized. This position will also lead team meetings, develop the UM clinical staff, represent the UM Clinical unit at meetings when applicable, and escalate issues as appropriate. This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
Job Responsibility
Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements
Develops and implements approved departmental policies and procedures/workflows
Implements and monitors departmental performance standards
Performs ongoing monitoring and evaluation of departmental operations to assure optimal efficiency and effectiveness
Collaborates with department leadership to establish operational objectives for the business unit
Works with members of cross-functional teams to glean and provide information pertinent to operational goals and acts as an expert resource
Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others
Ensures timely and accurate submission of reports/documents to organizational leaders and regulatory agencies
Assures appropriate department interface with key internal and external stakeholders
Participates in the development of and is responsible for the implementation of operational business plans and departmental objectives to support organization strategies
Contributes to departmental statistical, quality and performance reports
Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations
Provides input for the departmental budgets
Leads various committees and workgroups
Assures the maintenance of positive relationships with other departments, PPGs, other Local Initiatives and Community Based Organizations
Implements, with approval, programs that improve the provision of services to members
Manages content for PPG trainings/JOMS
Responsible for oversight and adequate performance of direct line of business PPG delegated activities
Work with department leadership for enhancements as necessary
Develops and sustains active communications with PPGs
Provide administrative oversight of the L.A Care After Hours programs
Actively participates in regulatory audits
Performs other duties as assigned
Requirements
Bachelor's Degree in Nursing
At least 6 years of clinical nursing experience
At least 4 years of leading staff or supervisory/management experience
Minimum of 3 years of relevant health plan experience
Registered Nurse (RN) - Active, current and unrestricted California License
Excellent verbal and written communication skills
Strong problem solving, planning, and organizational skills
Ability to maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements
Nice to have
Experience with Medi-Cal, under-served and culturally diverse populations