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Community Liaison

Health Plan of San Joaquin

Community Liaison

French Camp, CA
Full Time
Paid
  • Responsibilities

    Do you want to work with an expanding team that values professional and personal growth while also receiving fantastic perks and benefits? We are seeking a Supervisor of Inpatient Nursing with a strong leadership skills and a passion for providing quality healthcare to our members.

     

    WHAT YOU WILL BE DOING:

    As the Inpatient Supervisor, you will be responsible for providing oversight of and coordinating daily operations in a manner that ensures that HPSJ, regulatory and contractual requirements related to concurrent review of inpatient activities are met. You will be supervising Concurrent Review Nurses and Intake Processors.

    • Plans and assigns work; monitors department workload; makes timely and effective adjustments.
    • Resolves or facilitates resolution of the most high risk and/or complex medical issues.
    • Researches identified inpatient activity issues, including quality concerns; recommends interventions; implements and monitors corrective action plans.
    • Monitors and analyzes established metrics; identifies trends and opportunities for improvements; makes recommendations based on findings.
    • Develops, implements and maintains standard policies and procedures that comply with applicable regulations, guidelines and NCQA standards; communicates to appropriate individuals in a timely and effective manner.
    • Assists in the development of department objectives, action plans and budgets; executes and monitors business plans.
    • Works closely with interdepartmental units to establish and improve workflow and processes: identifies issues and opportunities; resolves issues or makes recommendations as required.
    • Compiles, develops and submits routine and ad hoc reports.
    • Leads internal audits; assists in the development, implementation and monitoring of corrective action plans.
    • Prepares for and participates in regulatory audits; gathers information, maintains required reports, develops and monitors timely and effective corrective actions plans.
    • Promotes and maintains an environment that supports HPSJ’s strategy, vision, mission and values.
    • Hires, supervises and retains a competent staff.

    WHAT YOU WILL GET:

    • HPSJ Perks:
      • Competitive salary
      • Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
      • Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
      • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
      • Two flexible spending accounts (FSAs)
      • Employer-Paid Term Life and AD&D Insurance
      • Employer-Paid Disability Insurance
      • Employer-Paid Life Assistance Program
      • Health Advocacy
      • Supplemental medical, legal, identity theft protection
      • Access to exclusive discount mall
      • Education and training reimbursement in addition to employer-paid elective learning courses.
    • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
    • A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
    • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

     

    OUR VISION:

    • Continuously improve the health of our community.

    OUR MISSION:

    • We provide healthcare value and advance wellness through community partnerships.

    Required Skills

    WHAT YOU BRING:

    KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES

    Required

    • Strong clinical skills at the RN level as defined in California scope of practice guidelines.
    • Strong knowledge of Medi-Cal and/or Medicare and other standards and regulations that pertain to inpatient management.
    • Basic knowledge of NCQA and JCAHO standards.
    • In-depth knowledge of and proficient skills in administering protocols for utilization management, discharge planning and/or case management.
    • Strong knowledge of the healthcare issues affecting the underserved.
    • Strong knowledge of medical management information systems pertaining to inpatient activities.
    • Strong knowledge of the principles and practices of managed care.
    • Strong knowledge of audit processes, and the ability to effectively implement and maintain them.
    • Ability to assist in the creation of relevant department objectives, business plans and budget, and monitor same.
    • Strong knowledge of and ability to identify, monitor and analyze relevant data and implement relevant and effective interventions based on results.
    • Strong analytical and assessment skills.
    • Decision quality: Makes good and timely decisions that keep the organization moving forward.
    • Action oriented: Takes on new opportunities and tough challenges with a sense of urgency, high energy and enthusiasm.
    • Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
    • Directs work: Provides direction, delegates and removes obstacles to get work done.
    • Plans and aligns: Plans and prioritizes work to meet commitments aligned with organization goals.
    • Optimizes work processes: Knows the most effective and efficient process to get things done, with a focus on continuous improvement; can develop, implement and maintain processes.
    • Ensures accountability: Holds self and others accountable to meet commitments.
    • Drives results: Consistently achieves results, even under tough circumstances.
    • Organizational savvy: Maneuvers comfortably through complex policy, process and people-related organizational dynamics.
    • Being resilient: Rebounds from setbacks and adversity when facing difficult situations.
    • Courage: Steps up to address difficult issues, says what needs to be said.
    • Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
    • Strong oral and written communication skills with the ability to communicate with diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information and document according to standards.
    • Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
    • Strong interpersonal skills with the ability to establish and maintain effective working relationships with diverse individuals inside and outside of HPSJ.
    • Strong facilitation, problem solving and conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
    • Strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, and maintain effective, high performance teams.
    • Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
    • Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor.
    • Strong customer service skills.
    • Ability to design workflow and procedures.
    • Ability to develop and deliver relevant and effective training and supporting materials.
    • Intermediate mathematics skills, including basic algebra.
    • Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs.

    Required Experience

    WHAT YOU HAVE:

    EDUCATION AND EXPERIENCE

    Required

    • Graduation from an accredited nursing school; and
    • At least three years as a licensed nurse in a clinical setting; and
    • At least two years’ experience working with MediCal, Medicare or other state or federally sponsored programs; and
    • At least one year as a supervisor or two years as a lead in a substantially similar position in managed care; or
    • Equivalent combination of education and experience.

    Preferred

    • Bachelor’s degree in Nursing, Business or related field.

     

    LICENSES, CERTIFICATIONS

    Required

    • Unrestricted California Registered Nurse license.
    • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.
  • Qualifications

    WHAT YOU BRING:

    KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES

    Required

    • Strong clinical skills at the RN level as defined in California scope of practice guidelines.
    • Strong knowledge of Medi-Cal and/or Medicare and other standards and regulations that pertain to inpatient management.
    • Basic knowledge of NCQA and JCAHO standards.
    • In-depth knowledge of and proficient skills in administering protocols for utilization management, discharge planning and/or case management.
    • Strong knowledge of the healthcare issues affecting the underserved.
    • Strong knowledge of medical management information systems pertaining to inpatient activities.
    • Strong knowledge of the principles and practices of managed care.
    • Strong knowledge of audit processes, and the ability to effectively implement and maintain them.
    • Ability to assist in the creation of relevant department objectives, business plans and budget, and monitor same.
    • Strong knowledge of and ability to identify, monitor and analyze relevant data and implement relevant and effective interventions based on results.
    • Strong analytical and assessment skills.
    • Decision quality: Makes good and timely decisions that keep the organization moving forward.
    • Action oriented: Takes on new opportunities and tough challenges with a sense of urgency, high energy and enthusiasm.
    • Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
    • Directs work: Provides direction, delegates and removes obstacles to get work done.
    • Plans and aligns: Plans and prioritizes work to meet commitments aligned with organization goals.
    • Optimizes work processes: Knows the most effective and efficient process to get things done, with a focus on continuous improvement; can develop, implement and maintain processes.
    • Ensures accountability: Holds self and others accountable to meet commitments.
    • Drives results: Consistently achieves results, even under tough circumstances.
    • Organizational savvy: Maneuvers comfortably through complex policy, process and people-related organizational dynamics.
    • Being resilient: Rebounds from setbacks and adversity when facing difficult situations.
    • Courage: Steps up to address difficult issues, says what needs to be said.
    • Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
    • Strong oral and written communication skills with the ability to communicate with diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information and document according to standards.
    • Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
    • Strong interpersonal skills with the ability to establish and maintain effective working relationships with diverse individuals inside and outside of HPSJ.
    • Strong facilitation, problem solving and conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
    • Strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, and maintain effective, high performance teams.
    • Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
    • Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor.
    • Strong customer service skills.
    • Ability to design workflow and procedures.
    • Ability to develop and deliver relevant and effective training and supporting materials.
    • Intermediate mathematics skills, including basic algebra.
    • Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs.