Health Services Manager

Job Objective:

Responsible for the management and supervision of the day-to-day operations of the Health Services department.  The position directs effective and efficient delivery of health services affecting clients and staff in the administration of Case, Utilization and Quality Management.

 

Job Responsibilities:

Management of the Health Services Department will include but not be limited to the following tasks and functions:

 

1.       Selects, develops, trains and motivates qualified staff to effectively carry out department functions and provides for the continuity of managerial and specialized skills. Ensures that ongoing training is conducted to maintain continuity of distributed information and processes.  Conducts regularly scheduled department staff meetings. Conducts performance evaluations, and sets performance standards.

 

       2.  Ensures that all utilization functions are staffed appropriately and that all

            utilization processes are completed in a timely manner.

 

       3.  Oversees the generation and accuracy of regulatory reports to appropriate health

      plan, government agencies and internal management, and ensures applicable

      compliance standards in accordance with health plan, Department of Health     

      Services and other state and federal entities.

 

3.       Develops with the appropriate persons and committees, standards for quality of care and service; monitors and reviews statistical data to identify aberrant trends; coordinates and monitors corrective actions.

 

4.       Responsible for the coordination and results of all onsite audits to include: Dept of Health Services; health plans; credentialing, and any internal audits called for.

 

5.       In conjunction with the Medical Director, AVP of Health Services and the Director of Health Services, formulates delegates and evaluates medical management strategies and programs to be carried out at the departmental level.

 

6.       Attend and works with the Medical Director and others to prepare for Quality Management, Utilization Management and Credential Committees as required. Ensures that meetings are documented according to regulatory requirements.

 

7.       In collaboration with the Director of Health Services is responsible for the development, monitoring and submittal of annual Health Service Work Plans and Programs.

 

8.       Collaborates with Contract and Claims Departments to ensure that positive and productive communication is ongoing.

 

5.  Participates in regularly scheduled Utilization Review Committee, Utilization

     Management Committee, JOMs and other meetings as required.

 

6.  Submits weekly reports to Director of Health Services with regard to issues

     affecting the department.

 

7.       Ensures that health plan reporting requirements are met in a timely manner.

 

 

8.  Other duties as assigned.



Minimum Requirements:

Education:     Current California RN license.  Bachelors or Masters degree or equivalent healthcare or related field preferred.

Knowledge:   Utilization Management/Case Management knowledge; ability to analyze and problem-solve.                           

Experience:   3-5 years experience in a managed care setting.  At least three years supervisory experience in the managed care setting.

                         2-4 years experience in an acute care environment.