Manager, Health Care Services Outpatient Utilization Management RN

Local Jobs Centene Corporation
  • United States, Rancho Cordova, CA 95670 View on Map
  • Post Date: June 18, 2020
  • Apply Before : July 18, 2020
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Job Description

    Position Purpose: The Manager of Health Care Services plans, manages and oversees all utilization management, quality management, and potential quality Issues, including grievances, for all (currently 18) VA Community Based Outpatient Clinic nationally. Acts as the clinical liaison between Health Net, the VA Medical Center and subcontractors. Maintains clinical policies and procedures for each location.
  • Manages processes related to potential quality issues and grievances.
  • Provides supervision and technical guidance to the clinics’ RN Managers (subcontracted staff) on clinical matters.
  • Monitors and manages the medical records documentation, i.e., clinical reminders.
  • Oversees the performance improvement program including preparation of contractually required reports.
  • Trains staff on clinically related operational policies and procedures.
  • Manages one Health Net associate.
  • Functions as the liaison for clinical matters with the VA and subcontractors
  • Education/Experience: Bachelor’s degree. Master’s Degree preferred. Three years hospital/clinical nursing
    Five years managed care, UM and/or QM.

    Five years management/supervisory experience

    License/Certification: Must have and maintain current, valid and unrestricted RN license. Driver license

    This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

 

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