Requirements

Position Summary/Position

Under the direction of the Clinical Director of Utilization Management (UM), is responsible for the oversight of the Inpatient Review Team. In this capacity, he/she will work with hospitals and IPAs to ensure coordinated and continuous cost-effective quality healthcare for IEHP Members. Major Functions (Duties and Responsibilities)
1. Liable for the oversight of simultaneous and review audit for clinical need, suitability of administration and level of care. 

2. Liable for the everyday oversight of approvals for outpatient administrations or subordinate administrations in anticipation of the Member's release or progress to bring down level or more significant level of care. 

3. Answerable for guaranteeing that the simultaneous or review audit process incorporates alluding Members to Health Management, Health Education, Care Management, or other inside or outer projects varying. 

4. Liable for guaranteeing that the simultaneous or review survey process incorporates alluding cases that require doctor audit to the Medical Director in a convenient way. 

5. Liable for every day survey of the inpatient enumeration report with ensuing catch up with the Inpatient Review Team for any anomalies. 

6. Work intimately with the Inpatient Supervisors to survey the day by day inpatient efficiency reports and resulting catch up with the Inpatient Review colleagues for any insufficiencies. 

7. Work intimately with the Long-Term Care supervisor to guarantee smooth progress with changes starting with one consideration setting then onto the next setting. 

8. Work together with the Inpatient Review Nurse Supervisors on colleague execution assessments and instructing/directing remedial activity gatherings with the help of Human Resource agent, up to and including end. 

9. Liable for month to month reports, for example, Monthly Complex Cases, In-tolerant Days Denied, staff profitability, expected nature of care, and some other reports required for the inpatient group. 

10. Break down in-tolerant information, for example, bed day reports, for patterns, and looking into discoveries with UM Clinical Director and suggest open doors for development. 

11. Aid the advancement of inward and outer Policy and Procedure Manuals as vital. 

12. Liable for staff instruction/preparing, finish of yearly execution assessments of inpatient staff opportune, and guiding varying. 

13. Answerable for joint effort with Team Members, IPAs, medical clinics, and some other outside accomplices to help the objectives of the division and the vision of the association. 

14. Lead as well as partake in LEAN exercises. Administrative Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications 

At least five years' involvement with oversaw care with broad information on HMO and IPA activities with an accentuation on Concurrent Review and usage the executives. Training Qualifications 

Secondary school recognition or GED required. Favored Education 

Four-year certification from a licensed establishment liked. Proficient Licenses 

Ownership of a functioning, unlimited, and unhampered Registered Nurse (RN) permit gave by the California BRN required. Drivers License Required Yes, must have a substantial California Driver's permit and legitimate accident protection. Must qualify and keep up driving record to drive organization vehicles dependent on IEHP protection guidelines of close to three (3) focuses. Information Requirement 

Information on proof based clinically models and California Children Services (CCS). Abilities Requirement 

Diagnostic aptitudes, time the board, and critical thinking. Microcomputer applications (Microsoft Word and Excel, Access required) for use in all parts of an office situation. Great correspondence, relational and hierarchical aptitudes. Capacities Requirement 

Self-starter and a cooperative person. Must have a serious extent of tolerance. Pledge to Team Culture