15 Healthcare Administrators jobs in Torrance
Healthcare Management Consultant
Posted 10 days ago
Job Viewed
Job Description
Role Overview: We are seeking highly motivated and experienced Consultants to join our growing Health Payer/Provider Service practice. As a Consultant, you will play a pivotal role in delivering strategic projects, working closely with clients to tackle complex challenges in their service operations. This position requires deep healthcare industry expertise, exceptional consulting skills, and the ability to thrive in high-ambiguity environments.
Key Responsibilities:
+ Client Engagement: Work collaboratively with clients to understand their business objectives, diagnose problems, and design tailored solutions.
+ Project Delivery: Lead and contribute to workstreams in projects focused on contact center service strategy, CRM implementation and optimization, digital transformation, and operational improvement.
+ Data Analysis: Use data-driven approaches to identify insights, track performance metrics, and build business cases for change initiatives.
+ Technology Enablement: Provide thought leadership on leveraging CCaaS platforms, CRM systems, AI, and digital tools to enhance customer service capabilities.
+ Digital Service Improvement: Develop strategies to improve service delivery in digital modalities such as chat, mobile applications, customer portals, and self-service platforms.
+ Experience Enhancement: Focus on elevating member experience, provider experience, and employee experience through innovative and customer-centric approaches.
+ Stakeholder Management: Build strong relationships with client teams, including senior leaders, and facilitate workshops, meetings, and presentations.
+ Team Collaboration: Collaborate with internal teams to ensure seamless delivery and alignment with broader project goals.
+ Change Leadership: Support clients in driving organizational change and adoption of new processes, tools, and behaviors.
+ Thought Leadership: Contribute to the development of intellectual capital within the practice by identifying trends, challenges, and innovative solutions in the healthcare industry.
Travel Requirement: Travel for this role is expected and required, the amount of travel is variable depending upon the client and project.
Required Qualifications:
+ Minimum of 5 years of professional experience, with at least 2 years in a management consulting role OR equivalent experience as a manager in the healthcare industry.
+ Minimum of 2 years of experience working with health payers or providers.
Preferred Qualifications:
+ Advanced degree preferred (MBA, MPH, MHA, etc.).
+ Demonstrated ability to navigate and deliver in ambiguous, fast-paced environments.
+ Strong analytical and problem-solving skills, with proficiency in tools such as Excel, PowerPoint, and data visualization platforms.
+ Excellent written and verbal communication skills, with experience presenting to senior executives.
+ Knowledge of CCaaS platforms (e.g., Genesys, Amazon Connect, NICE, etc.), CRM systems, and AI solutions for customer service.
+ Expertise in workforce optimization, quality assurance, or customer experience improvement within contact centers.
Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New Jersey, New York or Washington as set forth below.We accept applications on an on-going basis and there is no fixed deadline to apply.
Information on benefits is here. ( Location Annual Salary Range
California $63,800 to $05,800
Colorado 63,800 to 177,800
District of Columbia 68,000 to 189,300
Illinois 59,100 to 177,800
Minnesota 63,800 to 177,800
Maryland 63,800 to 177,800
New York/New Jersey 59,100 to 205,800
Washington 68,000 to 189,300
Requesting an Accommodation
Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.
If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at or send us an email or speak with your recruiter.
Equal Employment Opportunity Statement
We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.
For details, view a copy of the Accenture Equal Opportunity Statement ( is an EEO and Affirmative Action Employer of Veterans/Individuals with Disabilities.
Accenture is committed to providing veteran employment opportunities to our service men and women.
Other Employment Statements
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Further, at Accenture a criminal conviction history is not an absolute bar to employment.
The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.
California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information.
Please read Accenture's Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.
Healthcare Change Management Senior Consultant
Posted 5 days ago
Job Viewed
Job Description
The Change Management Consultant will be responsible for supporting our client with the EHR implementation. This position will help lead and execute the development of core Organizational Change Management capabilities for an enterprise initiative to consolidate information technology (IT) functions onto a single managed IT services vehicle. You will develop and drive adoption of change management strategy for public sector IT transformation initiatives. Establishing and maintaining relationships with stakeholders across the landscape will be critical in ensuring alignment with program objectives. This position will be instrumental in supporting four critical pillars of change: User Participation and Buy-in, Communications, Leadership Support, and Business Process Training and Education.
The candidate will support the development of work products and deliverables; establish relationships with primary clients and stakeholders; and identify opportunities to improve processes. The candidate will also support business development across the MHS.
- Coordinate OCM plan preparation and execution
- Build change management plans that are aligned to overall program plans and are designed to guide audiences through the change phases, including all sponsor/manager, training, communications, and support activities required to successfully implement the change
- Design and deliver communication to inform the organization of the OCM program and upcoming organizational change
- Provide insight and manage coordinated change impacts across the impacted organizations/personas
- Evaluate and implement operational process improvement
- Guide client conversations towards effective outcomes
- Educate business partners about the value of change management and engage the community of change practitioners across the organization
- Contributes to the development of work products and deliverables; manages recurring tasks and work products
- Work with clients and team to identify opportunities for improvement
- Develop slide decks/presentations
- Collaborate with stakeholders to track progress on initiatives and workstreams
Minimum of Bachelor's Degree
Minimum 3-5 (5+ years preferred) of change management experience
Must be U.S. citizen and be able to obtain a Public Trust clearance
Knowledge of the use of Microsoft Office Products and related applications
Demonstrates abilities and success with identifying and addressing client needs: actively participating in client discussions and meetings; communicating a broad range of firm services; preparing concise, accurate documents
Must be organized, self-motivated and able to multitask in a fast paced and dynamic work environment
Demonstrated ability to excel both independently and as a team member in a lively, collaborative environment
Excellent written and verbal communication skills, including ability to present to executive leadership
Ability to managing deadlines and recurring deliverables
***MUST BE WILLING TO TRAVEL UP TO 75%***
- Advanced degree in Public Health, Health Administration, Organizational Change Management or Business Administration
- Experience in health care information technology (HCIT) consulting with a major healthcare organization or large-scale IT transformation project
- Experience with the DoD; Military Health System experience a plus
- PROSCI Change Management Certification
- CCMP Certification
The annual salary range for this position is $98,000.00-$163,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
Guidehouse is an Equal Opportunity EmployerProtected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at or via email at All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
**California residents preferred
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
Preferred Qualifications
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.
Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted 10 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
- Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
- Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
- Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
- Trains and supports team members to ensure high-risk, complex members are adequately supported.
- Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
- Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
- Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
- Local travel may be required (based upon state/contractual requirements).
**Required Qualifications**
- At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
- Ability to manage conflict and lead through change.
- Operational and process improvement experience.
- Strong written and verbal communication skills.
- Working knowledge of Microsoft Office suite.
- Ability to prioritize and manage multiple deadlines.
- Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
**Preferred Qualifications**
- LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
- Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
- Medicaid/Medicare population experience.
- Clinical experience.
- Supervisory/leadership experience.
**Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.**
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications • At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
**California residents preferred
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
Preferred Qualifications
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.
Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
**California residents preferred
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
Preferred Qualifications
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.
Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Local travel may be required (based upon state/contractual requirements).
At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
**California residents preferred
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
Preferred Qualifications
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.
Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Nurse Supervisor, Healthcare Services Utilization Management ( California )
Posted today
Job Viewed
Job Description
**California residents preferred
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
California licensure must be current and in good standing.
Preferred Qualifications
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.
Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.