RN Manager/Supervisor Full-time
CHI Health

RN Supervisor UM Prior Auth

apartment CHI Health location_onRancho Cordova, CA, US
Apply Now

Job Summary and Responsibilities

As the Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promoting the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines.

  • Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file.
  • Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals. Manages team schedule including requests for time off and assurance of coverage during physician office hours.
  • Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate.
  • Motivates and coaches staff to include new-hire training, problem solving, and special projects.  Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team.
  • Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers.
  • Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required.

 

***This position is hybrid, work-from-home and in-clinic/office.

***This position will work rotating weekends.

Job Requirements

Minimum Qualifications:

- 5+ years clinical experience.

- 3+ years Utilization experience in health plan/UM operations, Acute or subacute utilization review.

- Bachelors degree, or equivalent experience.

- Clear and current CA Registered Nurse (RN) license.

- Ability to demonstrate leadership and management skills.

- Knowledge of all applicable federal and state regulations as well as accreditation standards.

- Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements.

- Must have the ability to monitor, compile, report and analyze data/statistics.

- Requires excellent human relations, interpersonal and oral/written communication skills.

- Able to recognize and address the needs and concerns of customers.

- Ability to interact with all levels of the organization as well as with external contacts.

- Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications.

 

Preferred Qualifications:

- 7 years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred.

- Experience working with health plan auditors preferred.

- Working knowledge of InterQual preferred.

- Knowledgeable of NCQA and ICE preferred.

Where You'll Work

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

 

One Community. One Mission. One California 

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Aesthetic Full-time
LaserAway

Registered Nurse

apartment LaserAway location_onDavis, CA
Aesthetic Registered Nurse – $50/hr + $5/hr Weekend Differential Fixed Schedule: Thursday through Monday | No Overnights | Comprehensive Training Provided About LaserAway LaserAway is the nation’s leader in aesthetic dermatology. We specialize in advanced, non-surgical treatments that combine medical expertise and cutting-edge technology to help every patient look and feel their best. About The Role We’re seeking an Aesthetic Registered Nurse to join our growing team. In this role, you’ll deliver exceptional patient care, perform advanced laser and injectable treatments, and educate patients on customized plans for long-term results. You’ll work in a supportive, fast-paced clinic environment where teamwork, professionalism, and patient satisfaction come first. Compensation & Schedule $50/hour base pay + $5/hour weekend differential Fixed schedule for work-life balance (no overnights required) Full-time position with benefits and ongoing training Full weekends required What You’ll Do Perform non-surgical aesthetic treatments, including laser hair removal, tattoo removal, injectables, and skin rejuvenation Conduct consultations and skin assessments to design individualized treatment plans Educate patients on procedures, pre- and post-care, and available treatment options Maintain accurate documentation and uphold all clinical protocols Partner with Patient Care Coordinators and Location Directors to ensure seamless patient experiences Float to nearby clinics as needed to support clinic operations Why Join LaserAway Competitive hourly rate + weekend differential Full medical, dental, and vision insurance 401(k) with company match Paid time off Employee discounts on treatments and products Comprehensive hands-on training across all aesthetic modalities Career advancement into Lead Nurse and Regional Clinical Trainer roles Who Thrives Here Current state-issued Registered Nurse license required 1+ year of hospital experience (ER, ICU, Med-Surg preferred) — or 2+ years in aesthetics Strong communication and interpersonal skills Professional, dependable, and patient-centered Weekend and evening availability required Join LaserAway — where science meets beauty. Apply today to start your career with the nation’s leader in aesthetic dermatology. LaserAway is an Equal Opportunity Employer. We’re committed to creating an inclusive workplace and will provide reasonable accommodations as required by law. Benefits Summary LaserAway provides competitive compensation packages and a comprehensive range of benefits, including Medical, Dental, Vision, Disability and Life Insurance, a 401(k) plan with a company match, and additional ancillary benefits. We also offer Paid Time Off (PTO) in compliance with state and federal requirements, ensuring our employees are supported both professionally and personally. LaserAway also provides incentive compensation, including potential bonuses and commissions, depending on role and performance. IND3
RN Home Health Full-time
21st Century Home Health Services

Home Health Field Registered Nurse (RN)

apartment 21st Century Home Health Services location_onAuburn, CA
At 21st Century Home Health Services (21HHS) , we treat every patient with the same empathy, compassion, and understanding we would show our own family. With more than 600 employees, we are the largest home health agency in San Francisco and the fastest-growing in the Bay Area. Today, we care for more than 4,000 patients across San Francisco, San Mateo, Santa Clara, Santa Cruz, Alameda, Contra Costa, Solano, Napa, Yolo, Placer, El Dorado, and Sacramento counties—and we are actively expanding into Marin and Sonoma counties. Our clinicians are dedicated not only to the patients they serve, but also to one another. The results speak for themselves: hospital readmission rates at 21HHS consistently remain under 10%, compared to an industry average of over 15%. We’ve also set a new benchmark for employee satisfaction in home health. Recognized as a 2024 Top Workplace, 21HHS fosters an environment of support, growth, and recognition through open communication and professional development opportunities. Key achievements include: San Francisco Chronicle Top Workplaces in the Bay Area : Ranked 3rd among all medium-sized companies and 1st among home health agencies. National Recognition : Ranked 12th among medium-sized healthcare companies nationwide and 1st among home health agencies. Patient and employee feedback on Yelp, Google, Glassdoor, and Indeed further validates our commitment to quality care and workplace excellence. By prioritizing engagement and satisfaction, 21HHS attracts top clinical talent and delivers outstanding outcomes, cementing our place as a leader in home health. Please note: All opportunities at 21HHS require being in the field visiting patients in their homes. This entry-level Field Registered Nurse position is designed to develop fundamental nursing skills within a home health setting while gaining an understanding of the company's operational goals and efficiencies. It serves as a foundational role for registered nurses aspiring to advance into case management. This position works under an Case Manager Registered Nurse position. Coverage Area: Auburn, Colfax area. \n DUTIES AND RESPONSIBILITIES Providing hands-on patient care including, but not limited to (must be within RN license scope): PICC lines, Wound Vacs & Care ,Kangaroo & feeding Pumps, Management of NG, G, and J tubes, Staple & suture removal ,Drains such as, JP, Biliary, Nephrostomy, ,Foley/suprapubic catheters (insertion, removal, and troubleshooting), PleurX drainage system ,Trach care, Blood draws, Ostomy management ,SQ and IM injections, IV antibiotic/TPN administration and Compression wraps. Provides direct patient care as defined in the state Nurse Practice Act Implements a plan of care initiated and directed by the Case Management Registered Nurse Provides accurate and timely documentation within 24-48 hours consistent with the plan of care Assesses and provides patient and family/caregiver education and information pertinent to diagnosis and plan of care Assists the registered nurse in performing skilled needs procedures and duties, which include preparing equipment and materials for treatments and assisting the patient in learning appropriate self-care techniques Participates in coordination of home health services, appropriately reporting the identified needs for other disciplines (HHA, OT, PT, MSW, ST) to the Case Management RN or other disciplines Uses equipment and supplies effectively and efficiently Participates in personal and professional growth and development Performs other duties as assigned by the Case Management Registered Nurse Retrieves communication on assigned patients. Uses information received as a basis for establishing priorities of care Gives a timely and pertinent report to the Case Manager Records pertinent and concise information that will reflect the patients' needs, problems, capabilities and limitations, as well as the patients' response to nursing interventions Entries will accurately record any incident that has a bearing on the patient. Reports pertinent information timely to the Case Management Registered Nurse and to Provider Attends weekly Case Conferences as required to coordinate and communicate information regarding patient care and treatment Ensures patient privacy in maintaining medical records and when providing care. Maintains professionalism and seeks opportunities to enhance knowledge of clinical skills Maintains productivity standards as directed by the Case Management Registered Nurse . Completes and reviews Start of Care assessments, documentation, and plans of care with Case Manager, as needed. Participates in on-call duties as required by weekend rotation Job Specifications One (1) year of recent nursing (RN, LVN) experience required One year of home health care experience is preferred. Experience with high acuity patients is a plus Experience working with an interdisciplinary team is highly desired Graduate of an accredited school of nursing (Bachelor's degree) Current CA Registered Nurse License (RN) Current Basic Life Support (BLS) Card Valid CA Drivers License with acceptable driving record All license and certifications must be current at time of hire and sustained throughout employment Self- directed, Critical Thinker, Outstanding interpersonal skills, Organized, Computer literacy. Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist. Must maintain current with annual compliance training and certifications \n $130,000 - $160,000 a year Estimated Wage Range for Home Health Registered Nurse (RN): $130,000 - $160,000. Starting pay is based on relevant experience above the minimum requirements. Compensation for this position follows a pay-per-visit model, with the wage provided as an estimate. 21st Century offers comprehensive health benefits and a 401k plan with up to a 4% match. \n 21st Century is an equal opportunity employer, committed to fostering a diverse and inclusive workplace. We strictly prohibit discrimination or harassment of any kind, including but not limited to race, color, sex, religion, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, or any other characteristic protected under federal, state, or local law.
RN Director of Nursing Full-time
Rancho Seco Care Center

Director Of Nursing (DON)

apartment Rancho Seco Care Center location_onGalt, CA
Who we are: Rancho Seco Skilled Nursing facility is a 99 bed long term and skilled community located in beautiful Galt, California. The team is lead by a seasoned Admininistrator who has called Rancho home for over three years, surrounded by a savvy clinical team who has longevity in their postions and have achieved stellar clinical results. With this years state survey behind us, we look forward to focusing on making our team more dynamic and growing our acuity to better serve our residents and neighbors. What We’re Looking For: We’re looking for a dynamic Director of Nursing to lead our clinical team and provide our residents with an exceptional care experience. We need you to plan, organize, develop and direct the overall operation of your Nursing Service Department in accordance with current federal, state, and local standards, guidelines and regulations. What You Will Do: Ensure 24hour availability as nursing administration resource by providing on-call and telephone access or designating an alternative, qualified nursing staff member to do so. Interview, hire, and train employees; plan, assign, and direct work; appraise performance; reward and discipline employees; address complaints and resolve problems. Coordinate care and services to improve organization and implementation of plans of care, and quality of life and for all residents. Ensure proper assessment of all prospective residents prior to admission including visiting client at their home or in the hospital. Develop staffing plans that assure sufficient staffing to meet direct care needs, recommend numbers and types of nursing personnel necessary to provide care and maintain compliance. Audit clinical records for accuracy and completeness of comprehensive resident assessments, effective documentation reflecting resident responses to interventions and consistent implementation of plans of care by all staff and professionals, on all shifts. Conduct quality assessment and assurance activities, including regulatory compliance rounds, in all departments to monitor performance and to continuously improve quality. Lead and participate in interdisciplinary conferences as needed to develop adequate plans of care. Establish and maintain established policies, procedures, safety, environmental and infection control standards. Provide direct administrative and technical supervision of nursing, admissions and continuing care functions. Establish performance goals. Provide leadership in planning, organization, evaluation and fiscal management. Collaborate with executive management team on goals of our home. Collaborate with interdisciplinary team members to develop and promote programs to enhance the resident’s quality of life and healthcare. Ensure compliance with applicable local, state and federal regulations and the policies and procedures. Assist in the preparation of departmental budgets and allocation of funds based upon a review of department estimates and recommendations. What You’ll Bring: 2 years of DON experience in a California Skilled Nursing Facility preferred. Unrestricted RN license in the state of California Must be able to pass background check
RN Full-time
Rancho Seco Care Center

Registered Nurse (RN)

apartment Rancho Seco Care Center location_onGalt, CA
We are seeking a motivated charge nurse with excellent leadership and communication skills. As a successful candidate, you will provide assistance and care for patients, supervise nursing staff, offer guidance and support, maintain a clean and safe working environment, and ensure that all operational tasks are completed efficiently and on time. To excel in this role, you will need to be a licensed nursing professional with at least 1 year of experience in a healthcare environment. You should enjoy working with people, have excellent organizational skills, and the ability to work under pressure. Charge Nurse Responsibilities Record patients’ medical records and monitor vital signs. Supervising nursing staff and monitoring their needs. Coordinating daily administrative duties, including schedules, nursing assignments, and patient care. Overseeing patient admissions, transfers, and discharges. Mentoring and training new staff and providing support and guidance to all staff members. Monitoring medical charts and providing compassionate care and assistance to patients and families. Liaising with doctors and administrators and communicating any protocol changes to staff. Ensuring compliance with all health and safety regulations. Recording and maintaining accurate reports. Identifying issues or emergencies and responding in a calm and efficient manner. Charge Nurse Requirements Associate’s degree in nursing. Licensed as a RN Further certification may be required. Prior experience in a healthcare facility required. Excellent leadership, communication, and organizational skills. Compassionate with sound judgment and problem-solving skills. Proficient in Microsoft Office and medical software systems. Ability to handle stress and work shifts.
RN Full-time
Rancho Seco Care Center

RNA

apartment Rancho Seco Care Center location_onGalt, CA
Job Position: The primary purpose of your job position is to perform restorative nursing assistant procedures that maximize the resident’s existing abilities, emphasize independence instead of dependence, and minimize the negative effects of disability with an attitude of realistic optimism under the supervision of a restorative nurse. Qualifications: Must possess Certified Nursing Assistant license. Experience: Must have training in rehabilitative and restorative therapy practices.