Supervisor Care Management RN - USFHP

Role Summary

The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family Health Plan to achieve cost-effective utilization of resources. This is accomplished through the proactive coordination of services to move patients efficiently through the continuum of care and ensure referrals are reviewed and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted patients and outpatient referral requests.

Responsible for ensuring accurate and consistent application of and adherence to TRICARE policy guidelines, other regulations, and department policies and procedures. This position is responsible for staff schedules; oversees and supervises all areas of department operations. Works collaboratively and proactively with Director of Operations and USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly goals.

• Supervise case management and utilization management functions.
• Coordinate services to move patients efficiently through the continuum of care.
• Review medical necessity and authorize all admitted patients and outpatient referral requests.
• Ensure accurate and consistent application of TRICARE policy guidelines, regulations, and department policies.
• Oversee staff scheduling and department operations.
• Collaborate with leadership to develop and implement strategic goals.

• RN with coursework/training in nursing.
• Washington Registered Nurse License upon hire.
• 5 years of clinical experience.

• Bachelor's Degree in Nursing.
• Experience in acute inpatient, skilled nursing facility, home health, or community health nursing including care management, care coordination, discharge planning.
• 1 year of supervisory experience.

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We provide a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, paid parental leave, vacations, holidays, health issues time off, voluntary benefits, well‑being resources, and more.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Applicants in the Unincorporated County of Los Angeles:
Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please contact us where you can access an email link to submit your concern.