(RN) Care Management Utilization Review Supervisor - 120058
As a federally-funded institution, UC San Diego Health maintains a marijuana and drug free campus. New employees are subject to drug screening.
#120058 (RN) Care Management Utilization Review SupervisorFiling Deadline: Mon 11/28/2022
UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.
For the safety and well-being of the entire university community, the University of California requires, with few exceptions, that all students, faculty and staff be vaccinated against the COVID-19 virus and influenza before they will be allowed on campus or in a facility or office. For more information visit: Flu Vaccine Mandate / COVID Vaccine Policy
Special Selection Applicants: Apply by 11/29/2022. Eligible Special Selection clients should contact their Disability Counselor for assistance.
The Care Management department at UC San Diego Health is seeking an experienced UR review leader.
The Care Management Department Supervisor who focuses on Utilization Review (UR) functions as a subject matter expert in InterQual criteria, for payer specific requirements and acts as a liaison between the Care Management Department, inpatient clinical and ancillary teams. Coordinates training and education needs for the Utilization management and support personnel in the Care Management Department.
Responsible for the onboarding, training and orientation of new and existing staff members. Provides mentorship, coaching and oversight to the Care Managers especially as it relates to the UR functions. Serves as a resource for the Department and may also be assigned units for coverage as needed. Oversees the completion of complex case reviews and the resolution of issues and concerns related to utilization management, quality and documentation integrity. Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education to improve performance.
Facilitates an atmosphere of interactive management and the development of collegial relationships among case managers, social workers, other health care staff and faculty. Responsible for the implementation of the vision, mission, philosophy, core values, evidence based practice and standards of the organization as defined by the department. Represents the department on interdepartmental committees, community agencies, boards, and associations. Responsible for ensuring adequate staffing, assignments and coverage in order to fulfill the unit's business needs. The Supervisor models the mission, vision, and core values of the organization; supports evidence based practice to insure optimal outcomes.
While not required, a cover letter is highly recommended when applying to this position.
A Bachelor's of Science Degree in Nursing.
Registered Nurse (RN) license issued by the State of California.
Current BART certification, or BLS certification at time of hire with commitment to get BART within six months of hire date.
A minimum of five (5+) or more years of relevant experience.
Experience and proven success in ability to effectively supervise a team and to manage the complex workflow and multiple priorities involved with care coordination and case management.
Demonstrated experience with InterQual including a thorough understanding of InterQual criteria.
Proven experience with Medi-Cal State guidelines, TAR reviews, and CMS regulatory requirements.
Experience with planning, developing, conducting InterQual training programs for staff members on orientation or ongoing improvement of skills to ensure staff’s expertise.
Excellent written and verbal communication and interpersonal skills including tact, diplomacy, and flexibility in order to work effectively with providers, staff, patients, and community agencies in person and on the phone.
Demonstrated ability to maintain strong working relationships and communications with physicians and members of the health care team.
Experience in an acute care hospital setting.
Previous leadership experience.
Experience providing education to staff and physicians.
Certified InterQual Trainer
Accredited Case Manager or Certified Case Manager (ACM or CCM)
Clinical Nurse Specialist (CNS)
Certified Professional in Healthcare Management (CPHM)
- Must be able to work various hours and locations based on business needs.
- Employment is subject to a criminal background check and pre-employment physical.
Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.