Supv Health Care Services

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies. Health Net’s mission is to help people be healthy, secure and comfortable. The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

JOB SUMMARY:


The Supervisor of Health Care Services assists with the planning, management and oversight of utilization management, quality management, and potential quality issues, including grievances. Maintains clinical policies and procedures.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES: Provides appropriate supervision of Health Care Finders and clerical staff; oversees review and referral functions. Assists in collection and/or analysis of HCF review and referral statistics. Participates in MTF meetings as a resource person. Assists in selection and training of new personnel and perform regular UM audits. Helps to train staff on clinically related operational policies and procedures.



REQUIREMENTS:

 

Education:
Bachelor’s degree preferred.


Certification/License:Valid RN License.Valid Driver License.

Experience:Three years experience in hospital/clinic nursing. Minimum one year managed care experience. One to two years previous supervisory experience. Also desire med-surg/ICU/emergency/public health experience. Computer skills and UR/QA experience.

Knowledge, Skills & Abilities:Knowledge of established screening criteria (Milliman & Robertson and InterQual). Knowledge of clinical specialty areas of medical treatment and practices. Ability to apply established guidelines and regulations to specific situations. Strong communication and problem solving skills.

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

 

As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security.

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

 

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.