Special Selection Applicants: Apply by 02/26/2019. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Involves the collaborative process among clinicians (typically social services, discharge planning, utilization review, providers and patient throughput), that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the patient's complex medical discharge planning, transitions of care and ambulatory care needs, as well as the overall health and human service needs of our members. It is characterized by planning, advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Requires employing best practice, evidenced based tools for value based care working within a network of providers and contracted vendors. This position is in the UCSDH Population Health Services Organization and is aligned with the PHSO Quality, High Risk Care Management and Managed Care Operations teams for optimal value based member outcomes. Reports to Director, Network Medical Management/ Population Health Care Team.
The Assistant Director determines department objectives in accordance with overall strategic plan, with focus on performance improvement efforts to enhance work flow efficiencies, timely member referral approvals in accordance with established work flows. Processes referrals within UC San Diego Health Physician Group and Physician Affiliate Network with focus on supporting medically necessary care and optimal customer service for member engagement.
Managed Care Clinical UM operations and regulatory compliance leadership. This includes CCM and DM delegation compliance as it relates to certain delegated and value based contracts, requires NCQA site visits oversight for Clinically Integrated Network and Medical Center vendors and compliance with sub-delegation site audit requirements. Provider provider, vendor and customer education and ensures network availability and adherence to best practice for high quality care. Must possess a solid understanding of and ability with HMO contracts, case management and audit/ regulatory compliance as it relates to health plans and Department of Managed Health Care.
- Bachelor's degree in nursing or other healthcare profession, or related area, or equivalent combination of experience/ training.
- Registered Nurse (RN) issued by the state of California.
- Seven or more years of relevant experience.
- Experience and proven success in hospital management skills, with progressive expertise in case management, utilization review, discharge planning, home care and/or managed care.
- Must be able to work various hours and locations based on business needs.
- Employment is subject to a criminal background check and pre-employment physical.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, and several outpatient clinics. UC San Diego Medical Center in Hillcrest is a designated Level I Trauma Center and has the only Burn Center in the county. We invite you to join our dynamic team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html
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