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Pediatric Team Nurse Supervisor, Santa Barbara, CA


CenCal Health

Nurse Management

Santa Barbara, CA

September 20, 2018


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Pediatric Team Nurse Supervisor

Clinical or Medical

Posted: August 20, 2018
Full-Time
Santa Barbara, CA, United States

Job Details

Description

  • Supervision of Pediatric Team Nurses; reviews, disciplinary action and coordination of day-to-day activities
  • Provide education and training to health services clinical and administrative staff especially with topics related to California Children’s Services (CCS) members, providers and benefits.
  • Serve as a resource for other CenCal Health staff especially with CCS concepts
  • Train and orient new Nurses in the Pediatric Team
  • Assist Clinical Manager in the CCS WCM project: risk stratification, Health Assessment Tool development, formulating individualized care plans for high risk pediatric members
  • Collect data and prepare reports required by DHCS in relation to CCS WCM implementation
  • Assist Nurses with reviews for approvals and denials of health services
  • Identify areas for process improvements and assists with their implementation
  • Support administrative and clinical staff in answering phone inquiries
  • As assigned, perform retrospective claims review
  • Carry a daily caseload of utilization or case management activities for pediatric members as assigned; supports clinical staff with day-to-day activities related to the review, coordination, care planning, and transition of care
  • Interface with and serve as a resource to members and providers to clarify processes, answer questions, and address issues or concerns
  • Handle and resolve daily issues, concerns and disputes of unit staff
  • Provide new staff orientation and mentor activities
  • Assist and coordinate staff assignments and coverages
  • Identify problems or issues within established utilization management (UM) or case management (CM) processes, policies or procedures, and make suggestions for efficient resolution
  • Identify process-oriented opportunities for improvement
  • Assist with coordination and facilitation of regular staff meetings
  • Participate in internal and external audits

Qualifications

Education

Preferred

Bachelors or better in Nursing or related field.

Experience

Preferred

1-2 years: • Experience in Medi-Cal and Medicare managed care health plan
• Knowledge of managed care terminology, issues, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities • Knowledge of CCS eligibility concepts and case management processes • Knowledge of Medi-Cal guidelines, regulations and benefit limitations • Ability to clearly and effectively communicate verbally and in writing with providers, hospital staff and other health care providers
• Depending on unit assignment, knowledge of current UM and CM scope and standards of practice and related productivity expectations and goals

Licenses & Certifications

Preferred

Registered Nurse

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