Utilization Review Nurse Salary in San Diego, CA

Overall management of the entire nursing department and staffing levels. • Develop and implement nursing policies and procedures and ensure compliance. • Responsible for ensuring resident safety and that all residents are treated with utmost respect. • Develop and conduct in-services for the clinical staff. • Responsible for the recruiting, hiring and training of nursing staff. • Coordinates pharmacy services and destruction of expired/discontinued medication. • Liaison between the facility, physicians and family members. • Being a witness at a trial in the event of litigation. • Work closely with all other departments to ensure excellent overall resident care. • Responsible for department budgeting and reporting. • Responsible for keeping current on any regulation changes and disseminating this information appropriately. • Participate in QA, Utilization Review and Patient Care conferences. • Actively participate in and assist with all state surveys and required follow-up activity. • Coordinate MDS and care planning. • Conduct employee appraisals and resolve problems including disciplinary actions and terminations. • Must maintain employee and resident/patient confidentiality at all times. • Provide direct/hands-on resident/patient care as needed.Supervisory Requirements The Director of Nursing is responsible for supervising and managing the ADON, and entire nursing staff either directly or indirectly. Qualifications Education and/or Experience Minimum requirements to perform this position include: Graduation from an Accredited School of Nursing with a Bachelor of Science Degree in Nursing, preferred (BSN). Must be in good standing with the State Board of Nursing and maintain all required continuing education/licensing requirements at all times. Minimum of 7 years nurse management experience preferred. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers and employees. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Certificates, Licenses, Registrations To perform this job successfully, an individual must be proficient in the Microsoft Suite products and Point Click Care (PCC). Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must occasionally lift and/or move up to 75 pounds. Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly required to sit, stand, walk and talk, read or hear. Frequent use of all office related equipment to include: copier/scanner/fax, telephone, calculator. Travel by auto or airline may be required. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually low to moderate. Additional Information Note: Nothing in this job specification restricts management's right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.

This position is responsible for the assessment, reassessment, care planning and coordination of care and services including ongoing monitoring of an appropriate and effective person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria. Responsible for the development of individualized care plans for high and moderate stratified members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member records, and works in conjunction with primary care, community benefits, and other support opportunities to develop a long term care plan to guide the member through their mental health care. Oversees the work of its assigned care support team and work with non-licensed support staff to meet standards of care and performance set by Member Market Leads and the Care Management Center of Operational Excellence (CoOE) Lead.Accountable for all Care Management activities for assigned high and moderate members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple clinical, social, and community resources.Provides telephone triage, crisis intervention and prior authorizations as assigned for select members stratified as high and moderate member need.Conducts in depth health risk assessment and/or comprehensive needs assessment including, but not limited to, psycho-social, physical, medical, behavioral, environmental, and financial parameters.Develops, documents, implements, and communicates the patient-centered care plan, which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.Educates providers, supporting staff, members and families regarding care management role and health strategies with a focus on member-focused approach to care.Serves as an accountable member of the care team to oversee appropriate rendering of services (e.g., during transitions in care or transition to home care, back up plans, community-based services).Oversees and effectively manages work assigned and conducted by assigned care support teamImplements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.Acts as an advocate for members' care needs by identifying and addressing gaps in care.Performs ongoing monitoring of members' care plan and measures the effectiveness of interventions as identified; develops plans that strive to meet Magellan developed KPIs in accordance with the CM CoOE Lead and Member Market Leads.Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.Works with members and the interdisciplinary care plan team to adjust plan of care as necessary.Facilitates a team approach, including all participants of the Interdisciplinary Care Plan team, Health Plan Medical Care Management where appropriate, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.Other Job RequirementsResponsibilitiesLicensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.One or more of the following licenses is required for this role with necessary degree: LMSW, LCSW, LMFT, LPC, or RN.Minimum 5 years' experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.Strong organization, time management and communication skills.Ability to manage and oversee activities of assigned care support teams.Experience with Care Management workflows.Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.Knowledge of and experience in inpatient and/or outpatient setting.Knowledge of DSM-5 or most current diagnostic edition.Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.Understanding of plan benefit structures, psychiatric/medical terminology, call center terminology and operations.Strong written and verbal communication skills.General Job InformationTitleCare Manager Health Plan, Remote, CA licenseGrade25Work Experience - RequiredBehavioral Health, HealthcareWork Experience - PreferredEducation - RequiredBachelor's - Nursing, Master's - Counseling, Master's - Social WorkEducation - PreferredLicense and Certifications - RequiredLCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtLicense and Certifications - PreferredSalary RangeSalary Minimum:$64,285Salary Maximum:$102,855This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Client Manager provides advice and assistance requiring technical and industry knowledge and client service skills to meet client needs and resolve difficulties. Client Managers may occasionally perform in the capacity of a Client Executive Service for specifically assigned accounts to oversee the preparation of and providing renewal and new business presentations.Essential Duties & ResponsibilitiesAct as the initial point of contact for Clients, Carriers and others on the Client Service Team in the following areas:RFP review and preparation.Analysis of utilization reports, carrier reports and claims data and trends.COBRA, HIPAA and coordination of 5500 data.Work closely with and instruct carrier representatives to ensure smooth implementation of new plans.Ensure required plan information and materials are sent to the client in a timely manner.Guide and mentor Benefit Analysts throughout the process of gathering Client census and benefit plan information used to prepare materials for new business presentations, renewals and open enrollment meetings.Explain client needs and concerns focusing on how various plan designs and recommendations address those issues.Review renewals, new business presentations, and open enrollment materials to ensure they are accurate and complete in content, are compliant with company and regulatory guidelines, and reflect a professional appearance.Ensure that client files and documentation are maintained according to policy and procedures, and consistent with Marsh & McLennan professional standards.Develop analytical, customer service and communication skills needed to perform as a Client Manager II.Present to Client Service or Sales Executive the financial measures used to predict and analyze plan benefit costs, and the factors which influence those costs and premium rates.Under the guidance of the Client Executive Service, participate in prospect and renewal meetings to learn client needs, challenges and concerns.Learn best practices to present renewal outcomes to the client and provide recommendations based on the findings with the ultimate goal being to take on these responsibilities.Conduct employee open enrollment meetings to communicate benefit options.Respond to and resolve routine issues the client may encounter regarding receipt of benefit services and coverage questions.Keep Client Executive Service apprised of potential E&O concerns and client dissatisfaction. Strategize with Client Executive Service to develop possible resolutions and proactive solutions to avoid continued or future problems.Education and/or ExperienceMust possess a strong understanding of health and welfare plan benefits and carriers such that this expertise is recognized by colleagues and clients. This level of expertise is generally acquired through 5 years' experience providing group health and benefits sales or service while at a brokerage or carrier.Bachelor degree strongly preferred.Strong communication skills with the ability to provide non-technical explanations to technical matters, and summarize and present information in a clear, concise and accurate written and verbal format.Strong knowledge of employee health insurance carriers, their strengths and weaknesses, plan design features as well as the general factors which affect cost and plan design.Maintain a valid unrestricted Life and Disability License in California and meet the continuing education requirements.Maintain a valid driver's license and dependable transportation.Proficiency with Microsoft Word, Excel and PowerPoint to include work experience creating tables, charts, graphs, pivot tables and formulas.Work Environment & Physical DemandsAbility to use computer keyboard and sit in a stationary position for extended periods as well as use of office equipment such as fax and copy machines, and telephones. Work is performed in a typical interior/office work environment.Travel to client sites is required. Usually within driving distance, but occasionally consists of 2 - 5 night stay out of town.The applicable base salary range for this role is $60,000 to $128,000. The base pay offered will be determined on factors such as experience, skills, training, location, certifications, and education. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives. We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. Marsh & McLennan Agency offers competitive salaries and comprehensive benefits and programs including: health and welfare, tuition assistance, 401K, employee assistance program, domestic partnership benefits, career mobility, employee network groups, volunteer opportunities, and other programs. For more information about our company, please visit us at: http://marshmma.com/careers.#LI-DNI#MMAEHB

Careers that Change Lives Bring your talents to an industry leader in medical technology and healthcare solutions - we're a market leader and growing every day. You can be proud to sell medical technologies that are rooted in our long history of mission-driven innovation. Our expanding portfolio delivers measurable clinical and economic value - and opens doors. You will be empowered to shape your own career. We support your growth with the training, mentorship, and guidance you need to own your future success. Together, we can transform healthcare.Join us for a career in sales that changes lives.The Ear, Nose, and Throat Operating Unit is a global leader and trusted partner for innovative ENT solutions that improve patient access, outcomes, and customer satisfaction. We partner with the ENT community to understand the needs of customers and patients, delivering solutions that improve lives as we embody a culture of accountability and trust. Over the past 20 years, we have become the global market leader in three key segments - image-guided surgery, intraoperative nerve monitoring, and powered surgical instruments. We continue to launch valuable ENT solutions in these areas as well as tissue health and balloon sinus dilation.Click here to learn more about products.The Market Development Representative is responsible for case support and selling activities. This role reports to the local district manager but has a dotted line to 1-3 area sales managers where accounts have multiple team members. The majority of time is spent maintaining established customer relationships and expanding utilization of current and adjacent products in the ENT portfolio.Responsibilities may include the following and other duties may be assigned. Responsible for developing, building, and strengthening long-term relationships with stakeholders including surgeons, nurses, administrators and key opinion leaders. Responsible for pursuing leads, assessing needs and providing product support and services to maximize the benefits derived from Medtronic's ENT products and/or services. Provides technical support during cases and informs the clinician of patient treatment options. Promotes education of the company's products and/or services. Conducts and/or evaluates market research including customers and competitors' activities. Develops and/or implements market development plans/strategies and changes as needed. Assesses customer needs and feedback regarding new products and/or modifications to existing products and communicates to internal stakeholders including R&D, Operations and Marketing. Establishes effective relationships and collaborates with other departments (Marketing, Finance, HR, Sales Training, etc.) to address key business issues and opportunities. The above statements are intended to describe the general nature and level of work being performed by employees assigned to this position, but they are not an exhaustive list of all the required responsibilities and skills of this position. We seek out and hire a diverse workforce at every level: We need fresh ideas and inclusive insights to continue to be an innovative industry leader -that's why we make it a point to seek out, attract and develop employees who are patient-centric, passionate, and who represent the same wide variety of life experiences as our patients.To learn more about Inclusion & Diversity at Medtronic Click Here Must Have: Minimum Requirements To be considered for this role, please ensure these minimum requirements are evident on your resume. A Bachelor's degree Nice to Have 2 Years of sales or clinical experience Operating Room Experience Relationships within the ENT space Preference will be given to local qualified candidates and candidates with Medtronic experience. About Medtronic Together, we can change healthcare worldwide. At Medtronic, we push the limits of what technology, therapies and services can do to help alleviate pain, restore health and extend life. We challenge ourselves and each other to make tomorrow better than yesterday. It is what makes this an exciting and rewarding place to be.We want to accelerate and advance our ability to create meaningful innovations - but we will only succeed with the right people on our team. Let's work together to address universal healthcare needs and improve patients' lives. Help us shape the future. Physical Job Requirements Required to function using healthcare universal precautions to minimize exposure to infectious disease and radiation. Ability to serve as the primary resource for scheduled and unscheduled clinical events, periodically required to work weekends, evenings and nights and may be required to engage in overnight travel within own district or neighboring districts. Ability to work efficiently and autonomously with little direction when outside of clinical events. Ability to attend national meetings, district meetings and other training as requested. Ability to wear a 7-9 lbs protective lead apron for extended periods of time in the operating room. Ability to lift up to 40 pounds. Ability to sitting, standing, and/or walking for 8+ hours per day. Ability to bend/stoop, squat and balance frequently. • Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus in relation to travel and operating a personal computer.Must have a valid driver's license and active vehicle insurance policy. In addition, your driving record will be reviewed and will be considered as part of your application. Must be able to drive approximately 50% of the time within assigned territory and may require overnight travel.The physical demands described within the Day in the Life section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.A commitment to our employees lives at the core of our values. We recognize their contributions. They share in the success they help to create. We offer a wide range of benefits, resources, and competitive compensation plans designed to support you at every career and life stage. Learn more about our benefits here .In addition to Base Salary, this position is eligible for a Sales Incentive Plan (SIP), which provides the opportunity to earn significant incentive compensation for achieving or exceeding your goals. Learn more about total rewards here .The base salary range is applicable across the United States, excluding Puerto Rico and specific locations in California. The offered rate complies with federal and local regulations and may vary based on factors such as experience, certification/education, market conditions, and location. Compensation and benefits information pertains solely to candidates hired within the United States (local market compensation and benefits will apply for others).