Current jobs related to Um Nurse Lead Capped - Woodland Hills - MedPOINT Management
-
Woodland Hills, United States Axelon Full timeLocation: Remote-needs to live in C SHIFT: Monday through Friday 8am to 5pm (PST) Duration:5+ month, This is a TEMP contract for a FTE on leave Walk me through the day to day responsibilities of this the role and a description of the project: Summary: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate...
-
Labor and Delivery Nurse Specialist
1 week ago
Woodland, California, United States Lead Health Full timeLead the Charge in Labor and Delivery NursingWe're seeking a skilled Labor and Delivery Registered Nurse to join our team at a top healthcare facility in Woodland, California. As a Travel Nurse with Lead Health, you'll enjoy a high-paying and flexible lifestyle with low stress and full benefits.Key Responsibilities:Provide exceptional patient care in Labor...
-
Case Management
2 months ago
Woodland Hills, United States Blue Shield of California Full timeYour RoleThe Care Managementteam will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are...
-
Registered nurse
3 days ago
woodland, United States Lead Health Full timeWe need a Emergency Room Travel RN to make a positive impact on patient care! There are Travel Nurses and then there are Travel Lead-ers! Lead Healthstaff is here to help you lead the charge forward in your healthcare career. Your needs, your preferences, and your desires matter above all else as we curate the perfect assignment options for you. Escape...
-
Traveling ER Nurse
2 days ago
Woodland, California, United States Lead Health Full timeLead the Charge in Your Healthcare CareerWe're seeking a skilled Emergency Room Registered Nurse (RN) to join our team at Lead Health. As a Travel RN, you'll have the opportunity to make a positive impact on patient care while enjoying a high-paying and flexible lifestyle.Key Benefits:Competitive weekly payComprehensive medical, dental, and vision...
-
Supervisor, Operations
1 month ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to members in maintaining health and wellness in the outpatient setting. The supervisor will report to the Manager of Care Management Operations. In this role you will supervise the Population Health Management Adult and Family Care Service...
-
Case Management
2 months ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are...
-
Case Management
3 months ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are...
-
Case Management
3 months ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are...
-
Case Management
3 months ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are...
-
Travel Nurse RN
9 hours ago
Woodland, California, United States Lead Health Full timeUnlock Your Potential as a Med-Surg Travel RNWe're seeking a skilled Med-Surg Registered Nurse to join our team at a top healthcare facility in Woodland, California. As a Travel RN, you'll have the opportunity to make a positive impact on patient care while enjoying a high-paying and flexible lifestyle.Exceptional BenefitsCompetitive weekly payComprehensive...
-
Supervisor, Operations
4 weeks ago
Woodland Hills, United States Blue Shield of California Full timeYour Role The Care Management team will serve to support the mission of the department, which is to provide support to members in maintaining health and wellness in the outpatient setting. The supervisor will report to the Manager of Care Management Operations. In this role you will supervise the Population Health Management Adult and Family Care Service...
-
ICU RN Position
3 days ago
woodland, United States Lead Health Full timeWe need a Critical Care - ICU Travel RN to make a positive impact on patient care! There are Travel Nurses and then there are Travel Lead-ers! Lead Healthstaff is here to help you lead the charge forward in your healthcare career. Your needs, your preferences, and your desires matter above all else as we curate the perfect assignment options for you. Escape...
-
RN Care Navigator
3 weeks ago
Woodland, California, United States Unavailable Full timeJob SummaryWe are seeking a highly skilled and compassionate RN Care Coordinator to join our team at Unavailable. As a key member of our healthcare team, you will be responsible for overseeing the progression of care and discharge planning for identified patients requiring these services.Key ResponsibilitiesCollaborate with utilization management, nursing,...
-
Travel Nurse ICU Specialist
2 weeks ago
Woodland, California, United States Nurse First Full timeJob Title: Travel Nurse ICU SpecialistJob Type: Travel NursingLocation: Woodland, CaliforniaJob Description:Job Summary:Nurse First is seeking a highly skilled and experienced Travel Nurse ICU Specialist to join our team. As a Travel Nurse ICU Specialist, you will be responsible for providing high-quality patient care in a fast-paced Intensive Care Unit...
-
Travel Nurse ICU Specialist
2 weeks ago
Woodland, California, United States Nurse First Full timeJob Title: Travel Nurse ICU SpecialistJob Type: Travel NursingLocation: Woodland, CaliforniaJob Description:Job Summary:Nurse First is seeking a highly skilled and experienced Travel Nurse ICU Specialist to join our team. As a Travel Nurse ICU Specialist, you will be responsible for providing high-quality patient care in a fast-paced Intensive Care Unit...
-
Merchandising Specialist
2 weeks ago
Woodland Hills, United States SAS Retail Services Full timeWe want you to help us shape the future of shopping experiences and deliver on our purpose of connecting people with the products and experiences that enrich their lives. Joining SAS Retail Services, an Advantage Solutions company, means joining a network of 65,000 teammates serving 4,000+ brands and retail customers across 40+ countries. All the while,...
-
Woodland, United States American Traveler Remote Work Freelance Full timeAmerican Traveler is offering a rewarding Labor & Delivery Registered Nurse (RN) contract position in Woodland California. Shift: Nights 12 Job Length: 16 weeks -- RNs who work with us receive a highly competitive pay and benefits package. You'll enjoy the personalized client service that has earned us high ratings from travelers nationwide -- and the...
-
Travel Nurse RN Position
5 hours ago
Woodland, California, United States Travel Nurse Source Full timeTravel Nursing Opportunity with Health CarouselWe are partnering with Health Carousel Travel Nursing and Allied Health to find a qualified Telemetry RN for a 16-week assignment in Woodland, California.Assignment Details:Estimated Start Date: Not SpecifiedLocation: Woodland, CAShift: DaysHours Per Week: 36About the Position:As a Telemetry RN with Health...
-
Travel Nurse RN Position
4 hours ago
Woodland, California, United States Travel Nurse Source Full timeER Travel Nurse Job OpportunityWe are working with Health Carousel Travel Nursing and Allied Health to find a qualified ER/Trauma RN for a 13-week assignment in Woodland, California.Pay Information: $2,234 per weekAbout the Position:Estimated Start Date: Not SpecifiedLocation: Woodland, CAShift: NightsHours Per Week: 36About Health Carousel Travel Nursing...
Um Nurse Lead Capped
5 months ago
**Summary**:
Provides leadership, support, training, and direction to the Inpatient UM teammates. The incumbent will use clinical judgment to provide utilization management review for inpatient during high volume situations. Provide high quality, cost-effective care to enable patients to achieve maximum medical improvement, while receiving care deemed medically necessary.
**Duties and Responsibilities**:
- Conducts review of the TMs timecard (T&A) and 30-days, 60-days, 90-days, 6-month, and annual performance evaluations for assigned UM TM’s. Provides performance feedback to the UM staff and conducts staff trainings as needed.
- Provides leadership, direction, training, and support to the assigned team and remote Inpatient UM staff.
- Assists in the development and updates department Policies and Procedures, Workflows, and SOP’s as needed.
- Assists in organizing and coordinating Team Meetings and plans team building exercises. Assists in research and gathering of details needed for HP CAP responses; reinforces MPM Policies and provides Corrective Action Plans to staff when needed
- Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements, and IPA policies and procedures for each product line.
- Leads the clinical review process for assigned team and assigned remote Inpatient UM staff and escalates any issues identified during rounds to the Inpatient UM Supervisor
- Monitors daily workload, daily open cases for nurses to assess and determine staffing needs
- Ensures minimum productivity standards are met, including assisting with current workload when timely review and/or discharge may be in jeopardy.
- Works with other MPM departments to resolve issues relating to authorization of medical services and assists Inpatient UM staff with member’s grievances.
- Leads Inpatient UM staff with the daily huddle with hospitalist, Medical Directors for Outlier Cases: for acute and Skilled Nursing Facility (SNF)
- Assists nurses in identifying and referring eligible cases to the Re-admission Team, Case Management, Transition of Care, Behavioral Health, Post-Discharge Clinics or other internal or external programs (i.e. MedZed, Enhanced Care Management, Community Support services, CAW, Landmark) as needed.
- Reviews Denial Verbiage for nurses to ensure accuracy before Denials are sent to the Denial Team for processing with guidance from the Inpatient UM Nurse Supervisor as needed.
- Provides oversight of DENCs and NOMNCs to ensure accuracy and compliance.
- Responsible for coverage for vacation relief and sick calls, will have modified work assignment.
**Minimum Job Requirements**:
- Knowledgeable of all MPM databases, proper usage, and date fields/ logic used by their team.
- Current RN or LVN licensure; Preferred: BSN level of education.
- Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision support criteria, discharge planning, and reimbursement structures (i.e. Government and non-governmental payers).
**Skills and Abilities Required**:
- Excellent notetaker with the ability to relay large amount of information in a digestible format and ability to efficiently scrub data to understand errors and/ or key assumptions.
- Ability to identify improvement opportunities and set realistic goals for the TM’s to achieve and mentor TM’s as a coach and tailor their style to each TM personally.
- Ability to communicate effectively with direct TM’s both in meetings and written communication, wide range of hospital personnel, physicians, patients/family members within various socioeconomic groups and representatives of varied outside agencies.
**Salary Range**:
- $93k-$95k annually
