Partnership HealthPlan of California

Supervisor of Long Term Support Services (LTSS)

Job Locations US-CA-Redding | US-CA-Fairfield
Job ID
2024-3053
FLSA Status
Exempt
Hiring Range
$ 120,686.00 - $ 156,735.06

Overview

To provide daily supervision and LTSS program support to designated staff. Assists departmental
leadership in developing and maintaining a cohesive team with a high level of productivity, accuracy
and quality to achieve goals and objectives.

Responsibilities

  • Provides daily leadership, direction, resources, training, evaluation, coverage and program support to assigned staff.
  • Serves as a role model and resource to colleagues, staff, members, and others.
  • Assists department leadership in identifying, monitoring, and evaluating department operations to ensure optimal efficiency and effectiveness. Makes recommendations for process improvements when necessary.
  • Performs supervisory functions such as timecard management, directing work activities, conducting annual reviews and staff training.
  • Assists in development of, and provides supervision for, evidence-based best practices and activities to address LTSS benefits and/or services (ex: Transitional Care Services, facility placements, care coordination, etc.)
  • Participates in interdisciplinary rounds.
  • Supervises concurrent review process for all LTSS services.
  • Participates in quality-monitoring activities to improve the quality of care, outcomes and/or costs for members receiving one or more LTSS (ex: Skilled Nursing, Community Based Adult Services, In-Home Support Services, etc.).
  • Collaborates with Partnership’s LTSS Liaison to address provider requests for assistance and/or the identification of providers interested in contracting with Partnership.
  • Maintains active participation with inbound and outbound provider reporting and other related duties, adjusting assignments as necessary to meet business needs and/or regulations.
  • Supports the hiring and on-boarding processes of new staff by identifying talent, developing training plans and providing feedback to new staff.
  • Participates in committees, workgroups and/or multidisciplinary teams to support Partnership’s strategic plan, organizational goals, and/or business needs.
  • Facilitates meetings with Partnership providers and/or external community partners as necessary.
  • Supports organizational collaboration and communication regarding UM and LTSS program initiatives.
  • Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC CMS regulatory requirements, Partnership Policies and Procedures, and medical necessity tool criteria for each product line.
  • Develops and maintains positive working relationships with all business partners to ensure optimum member care and provider satisfaction.
  • Reviews department desktops, policies and procedures, recommends changes for more efficient operations, and communicates changes and updates to staff when appropriate.
  • Researches and responds to provider issues or barriers ensuring successful outcomes and superb customer service.
  • Participates in special projects and assignments as required.

Qualifications

 

Education and Experience

 

Associate or Bachelor’s degree in nursing. RN with 3-5 years’
experience to include staffsupervision; 2 years’ managed care (case
management) experience; or equivalent combination of education and
experience. General knowledge of managed care with emphasis in case
management preferred.

 

Special Skills, Licenses and Certifications

 

Current Valid California RN license. RN Supervisor will be supervising
both RN and LVN staff. Strong knowledge of nursing requirements in a
clinical setting. Knowledge of utilization management programs as
related to use of pre-set criteria and protocols.
Familiarity with business practices and protocols with ability to access
data and information using automated systems.
Ability to work within an interdisciplinary structure and function
independently in a fast-paced environment while managing multiple
priorities and meeting deadlines.
Strong organizational skills required. Effective telephone and computer
data entry skills required. Valid California Driver's License and proof of
current automobile insurance compliant with Partnership’s policies are
required to operate a vehicle and travel for company business.

 

Performance Based Competencies

 

Desired competencies (ex: Knowledge of DHCS, Medi-Cal, CMS,
medically necessary criteria, CalAIM and/or NCQA regulations.
Ability to work within an interdisciplinary structure and function
independently in a fast-paced environment while managing multiple
priorities and deadlines. Strong organizational skills required.
Computer literacy and proficiency. Excellent written and verbal
communication skills in English. Demonstrated experience and ability
to build effective working relationships and to represent the department
effectively in order to accomplish goals. Ability to manage multiple
concurrent projects and maintain a work pace appropriate to the
workload. Ability to assist individuals in recognizing and solving
problems. Ability to supervise, train, motivate, provide guidance to
staff.

 

Work Environment And Physical Demands

 

Ability to use a computer keyboard. Ability to prioritize workload and
initiate action to acquire needed information from professionals by
phone. Ability to function effectively with frequent interruptions and
direction from multiple team members.
More than 50% of work time is spent in front of a computer monitor.
Must be able to lift, move, or carry objects of varying size, weighing up
to 10 lbs.
Some travel required (up to 25%) including occasional overnight.

 

 

 

 

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated. 

HIRING RANGE:

 

$ 120,686.00 - $ 156,735.06

 

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed