Supervisor - Utilization Management - Rn

Scripps Health Administrative Services supports our five hospitals and 19 outpatient facilities, which treat half a million patients annually through 2,600 affiliated physicians.

At Scripps Health, you will experience the pride, support and respect that has been repeatedly recognized as one of the nation’s Top 100 Places to Work. You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So, if you’re open to change, go ahead and unlock your potential.

As Supervisor, Utilization Management, also known as Supervisor, Case Management, you will be supporting Scripps Health Plans. You will be responsible for the day-to-day operations of the managed care case management department and oversee the utilization management, discharge planning/placement, and case management functions.

You will lead a team that is dedicated to creating an environment that is focused on restoring function and optimizing care, while maintaining the respect, autonomy and individuality of every patient. You will have the support of your team to ensure optimal patient care and success in your role.

As Supervisor, Utilization Management, you will assure compliance with Federal, State, NCQA, and other regulatory agencies and internal standards and requirements. Provide oversight and direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care to ensure patient care quality. As Supervisor, you will assist in conducting statistical studies in utilization trends, patterns, and outcomes to ensure compliance with all regulatory standards.

This is a full time, salaried position with benefits located in 4S Ranch.

Preferred Education/Experience/Specialized Skills/Certification:

• One year of Utilization Management RN experience.
• One year of applicable leadership experience.
• BSN, knowledge of health plan benefit coverage and regulations.
• Knowledge of managed care operations.

Required Education/Experience/Specialized Skills:

• Two years of experience in a lead or supervisory role.
• RN with a minimum of 3-5 years in a managed care clinical environment.
• Proficiency in MS Office software, and ability to quickly learn a variety of case management systems.
• Minimum of 2 years experience in case management/utilization review, discharge planning, and Millman/InterQual criteria usage.

Required Certification/Registration:

• CA RN license.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.