The Job
Provide oversight and support to Medical Management clinical staff, operations, and department adherence to protocol and procedures, regulatory compliance standards. Perform assessment of clinical staff performance, develop education and performance improvement plans.
You Will
- Responsible and accountable for unit operations to ensure staff perform functions compliant with all regulatory requirements, clinical standards and internal policies, procedures and metrics Promote compliance with and adhere to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies such as the National Committee for Quality Assurance (NCQA)
- Provide oversight to the overall quality of nursing activities and staff functions in their respective areas of responsibility May manage a partial caseload to provide back up support to staff
- Ensure productivity and quality metrics are aligned with department goals and objectives
- Ensure competency and clinical performance by conducting regular audits to ensure quality and compliance and monitoring outcomes of Interrater Reliability testing Provide coaching and education Implement corrective action measures as needed
- Provide guidance and support to staff around complex clinical issues and the need for escalation
- Support the department needs around policy and procedures, desktop procedures, workflows and
- training materials. Ensure all material is current and accurate to provide consistent quality care and meet compliance with regulatory requirements
- Communicate with staff on job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, polices, and procedures as directed
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
- Actively support the achievement of SCAN's Vision and Goals.
- Other duties as assigned.
Your Qualifications
- Associate's Degree in Nursing. Bachelor's Degree preferred.
- RN license required
- 2-3 years of related experience - Knowledge of the field's policies, procedures, and practices. Leads and directs the work of other employees. 1+ years of leadership experience
- Experience with inpatient Utilization Management required
- Medicare Advantage knowledge required
- Leadership - Basic skills to develops others
- Problem Solving - Basic problem solving skills
- Communication - Good communication and interpersonal skills
- Ability to work as part of a team
- Oral and written communication skills
- Problem-solving skills
- Attentiveness
- Interpersonal skills
- Detail oriented
Base Pay Range: $92,400 - $133,671 per year
Work Mode: Mostly Remote: Employees who reside outside the local area are expected to work remotely and travel to SCAN's headquarters approximately once per month for in-person meetings, team collaboration, training, and other business needs. SCAN's headquarters is currently located in Long Beach, California, and is expected to relocate to Cerritos, California, in 2027.