Manager, Delegation Oversight UnitPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
The Manager of the Delegation Oversight Unit develops, implements, supports and promotes clinical strategies, policies and programs that drive the delivery of quality healthcare to our members. The Manager, Delegation Oversight Unit is responsible for the day-to-day oversight and management of team processes including the organization and development of high performing teams. The primary responsibility centers around ensuring oversight and deliverables of our independent practice associations (IPA's) and leading the team that supports the work.
Fundamental Components include, but not limited to:
- Reinforces clinical philosophy, programs, policies and procedures. Communicates strategic plan and specific tactics to meet plan. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
- Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Accountable for meeting the financial, operational and quality objectives of the unit. Accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures.
- Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan. Develop, initiate, monitor and communicate performance expectations.
- Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills. Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
- Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
- Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
5+ years Clinical Practice experience; Required (Acute Care preferred)
3+ years utilization management experience is; Required
1+ years leadership and supervisory experience is; Required
Delegation Oversight Experience; Preferred
An active and unrestricted Registered Nurse (RN) Licensure within the State of California
Bachelor's in Nursing required and Master's degree in healthcare or related field preferred
- This individual will lead a newly formed Delegation Oversight Unit which includes providing oversight of our IPA's and ensuring respective deliverables are met.
- Experience working in a regulatory environment is preferred
- Experience with IPA's is preferred
- Some experience with concurrent review and prior authorization is preferred
- Medi-Cal experience is a plus!
Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required
• Ability to understand and create reports with productivity and service metrics; identify gaps
• Policy and procedure experience with a demonstrated ability to operationalize policies to desktops
• Dedicated advocate for plan and members
• Demonstrated ability to deliver presentations to both internal and external customers
• Knowledge of community resources and provider networks
• Presentation skills to both internal and external customers
• Familiarity with local health care delivery systems
• Experience working with diverse teams and populations
• Strong communication and organizational skills with an attention to detail.
• Ability to evaluate and interpret data, to identify areas of improvement, and focus on interventions to improve outcomes
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