RN Manager of Case Management - Irvine, CA

    • Irvine, CA

Position Description

Monarch Health is one of the largest associations of physicians and health care professionals in Orange County and Long Beach. Our network gives you lots of access to specialists, hospitals, skilled nursing, urgent care and more so you have the perfect fit for good health. Monarch is part of OptumCare, a care delivery organization that improves patient health and helps make health care work better.

The RN Manager of Case Management coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. This position may supervise any LOB, including Senior, Commercial, ACO or Government programs. The supervision includes case management, coordination or care and monitoring of the requirements for MOC and NCQA.

*This is an office based position, supervising a team of office based telephonic Nurses.

Primary Responsibilities:

  • Sets priorities for the team to ensure task completion and/or meeting MOC or NCQA guidelines
  • Coordinates work activities with other supervisors and representatives from health plans
  • Develops plans to meet short - term objectives
  • Identifies and resolves operational problems using defined processes, expertise and judgment
  • Decisions are guided by policies, procedures and business plan and health plan requirements
  • Guide and assure that staff are meeting health plan / NCQA guidelines in documentation. Participate in Health Plan audits.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Undergraduate degree or equivalent experience
  • Graduate of an accredited School of Nursing
  • Current, unrestricted RN license in the state of CA
  • 2 years experience as a manager working in hospital, acute, direct care, skilled settings OR experience as a telephonic Case Manager for an insurance company

Preferred Qualifications:
  • Prior Case management experience
  • Experience in supervising / leading a team
  • Experience in supervising teleworkers

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)

Monarch HealthCare®, is led by doctors who are committed to offering patients the most extensive choices and access to Orange County's leading physicians, hospitals, labs and urgent care centers. This allows patients to get the perfect care in support of their good health. Monarch HealthCare's independent, private - practice physicians are part of a coordinated network that works together to promote excellence in patient care.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN Case Manager, Case Management Supervisor, Monarch, case management, NCQA, telephonic case management, prior authorization, RN license, managed care, Monarch, Irvine, CA, California

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