Manager, Clinical Quality Review - RN

Your Role

The Clinical Quality Review team reviews potential quality issues that are received by our members, providers, or are internally identified by staff. In collaboration with our medical directors, the team follows up / reports results to the appropriate committees for further resolution. The Manager, Clinical Quality Review, will report to the Sr. Manager, Clinical Quality Review. In this role you will be providing oversight as assigned to a clinical team comprised of Registered Nurses (RNs), Behavioral Health Clinicians and administrative staff to ensure operational compliance with timeliness and reporting requirements.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Registered Nurse (RN) California license required
• Requires a bachelor's degree in nursing, Public Health, or other related field
• Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager
• Required at least 3 years of Health care / Managed care experience (i.e. broad knowledge of current concepts, practices and procedures within the health care field, especially related to HMO, Medicare, Medi-Cal - with extensive Medi-Cal knowledge and experience)
• Demonstrated experience in cross-functional operational leadership and in coaching, mentoring and guiding employees in areas related to change management and operational process improvement
• Demonstrated investigative, problem solving, critical thinking and assessment skills, working knowledge of industry related systems
• Excellent communication skills, both written and oral