Clinical Supervisor, Long Term Care

PRINCIPAL RESPONSIBILITIES: Under general direction of the Manager of Long-Term Care and working in cooperation with other departments, such as Utilization Management, the Clinical Supervisor, Long-Term Care (LTC) is responsible for providing health plan administrative and clinical support to staff and to Members on the admissions and continued stay services in LTC Nursing Facilities/Intermediate Care Facilities/Distinct Part Hospitals, Subacute Facilities, and ICF/DD Facilities. The position supports the day-to-day operations of the department by providing guidance and priority setting for front line staff and communicating operational issues to the Manager of LTC. The position uses clinical judgment and critical thinking skills to determine the appropriateness of LTC admissions as well as ongoing continued stay evaluations and transitional care services. The position will collaborate with the LTC facilities to ensure that appropriate physical /behavioral healthcare and social services are provided timely and efficiently for Alliance members. The Clinical Supervisor, Long term Care utilizes assessments, member-centered care planning, direct provider coordination/ collaboration, and coordination of psychosocial wraparound services to promote effective care available to Members. The Clinical Supervisor, Long Term Care will possess knowledge of current upcoming programs and services that intersect with LTC services, such as Enhanced Case Management, Community Support, Population Health Management, Regional Center Services, and Home and Community Based Services, (HCBS). The Clinical Supervisor develops, reviews and updates policies and procedures to ensure adherence of all DHCS, DMHC and NCQA standards.


Principal responsibilities include: Supervise day to day operations or applications within the scope of responsibilities including distribution of workload. Supervise and lead the provision of timely, efficient, equitable, and effective LTC services. Hold staff accountable for regulatory and departmental standards. Identify and manage personnel issues in a proactive and timely manner, with appropriate follow-up to improve performance. Ensure accurate documentation of the issue, plan, and oversight to ensure performance issues are resolved. Escalate ongoing/repetitive issues to Manager. Participate and/or lead organization quality improvement initiatives/projects as the LTC representative as required. Lead the training of staff as required. Monitor daily production goals. Identify root cause for any productions issue. Implement changes as necessary and monitor outcomes. Auditing of clinical staff reviews for appropriateness and adherence to regulatory and departmental processes. Supporting collaboration with Skilled Nursing Facilities (SNF) and Provider Medical Groups (PMG) to facilitate and coordinate authorization of services under the responsibility of the delegated PMG. Coordinate the identification, documentation, and resolution of LTC facility related issues in a timely manner. Assisting the LTC Manager in developing a successful and cohesive LTC UM/CM group with a high level of productivity to achieve the unit's overall performance. Create the daily assignment and distribution of work. Ensure the work is appropriately distributed amongst the entire team. Provide initial onboard training and remedial retraining to staff. Responsible for maintaining any training materials to align with the current process to improve member's health outcomes, prevent hospitalizations and meet regulatory requirements. Serves as content expert and guides the LTC UM/CM staff so that utilization . management, health navigation and case and disease management processes are conducted in a timely and efficient manner. Daily triage of clinical and non-clinical issues; identifying concerns and elevate to the Manager as needed. Demonstrate approachability, openness and remain available to colleagues for concurrent problem solving. Identify opportunities for process improvements to facilitate department functions and ensure compliance within applicable governmental program guidelines. Participate in data validation for reports and electronic document builds Audit Nursing staff documentation according to departmental standards. Prepare report and send to LTC Provide feedback and opportunities identified to the Manager of Long Term Care. Assess members for referral into Complex Case Management, ECM, and transitional care services . Work as part of a multidisiciplinary care team to support members as well as meet Alameda Alliance, regulatory and accreditation requirements Adhering to patient confidentiality, serve as a consultant to intra-departmental, other AAH departments and external groups regarding patient assessment and care; participate in program development and quality improvement initiatives Work proactively with providers, members, and community resources as necessary, to support the planning, implementation and evaluation of Case Management; identify areas of opportunity and/or education needs. Review existing authorization information in determination of goals and care planning. Document all assessments, member/vendor/provider interactions in a timely manner (TruCare) according to Alliance policies and regulatory standards Meet case load, productivity and efficiency goals as set by management Complete other duties and special projects as assigned. ESSENTIAL FUNCTIONS OF THE JOB Supervise day to day operations LTC clinical responsibilities. Performs clinical review of Skilled Nursing Facilities (NF-A/B), Subacute facilities and Intermediate Care Facility admissions and recertifications to validate the appropriate level of care as needed. Responsible for performing assessments of members referred to health plan programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, and social services as needed. Provides direction to staff members who assist members/providers with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum. Arranges for all services required while coordinating with the health care team to eliminate duplication of services. Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for LTC programs. Helps facilitate care coordination with internal and external entities to improve member's short- and long-term goals in collaboration with member, caregivers, family, support systems, and physicians. A person-centered approach will minimize member confusion and ensure that the best care is delivered in the most appropriate setting. Supports the Community Transition programs by evaluating identified institutional Members to determine if needs can be addressed through other avenues, such as, community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs. Documents accurately and comprehensively based on the standards of practice and current organization policies. Helps facilitate rounds along with Manager. Create and refine departmental documentation, including standards and procedures, guidelines, workflows, and other relevant records. Responsible for the timely revisions, maintenance, and storage of such documentation. Participate in strategic plan development and departmental goal planning with Manager and execute assigned goals. Serve as LTC "subject matter expert". Analyze operational and production reports on a daily, monthly, and quarterly basis. Ability to work in a complex team environment and to collaborate with both external and internal professionals and others.

Ability to demonstrate skills in prioritization, problem solving, team building, collaboration, conflict resolution, decision making and time management. Solid clinical skills in utilization, benefit management and clinical guidelines. Ability to function independently and deal with multiple, simultaneous projects. Ability to demonstrate a commitment to quality and excellence. Ability to provide effective feedback. Ability to write detailed policies and procedures. Experience with advanced functions of Microsoft Office suite and reporting tools preferred. Strong organization, time management and project management skills and multi-tasking abilities a must. Knowledge of appropriate state and federal UM and managed care regulations required. Hire, supervise, and train staff. Perform writing, administration, analysis, and report preparation. Problem identification and resolution. Participate and prepare in all regulatory audit activities for DHCS, DMHC, NCQA. Excellent verbal and written communication skills. Lead and participate in internal and external committees and meetings. Communicate effectively and efficiently internally and externally. Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls. Ability to perform all the functions of a LTC Nurse Specialist with a scaled back assignment. Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PMGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements. Performs other duties as assigned. PHYSICAL REQUIREMENTS Constant and close visual work at desk or on a computer. Constant sitting and working at a desk. Constant data entry using keyboard and/or mouse. Frequent use of telephone headset. Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person. Frequent lifting of folders and other objects weighing between 0 and 30 lbs. Frequent walking and standing. Occasional driving of automobiles. Number of Employees Supervised: 7-10 MINIMUM QUALIFICATIONS: EDUCATION OR TRAINING EQUIVALENT TO: BSN or MSN required. Active and unrestricted California Registered Nurse License. MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Three years of clinical case management or utilization management experience desired. Three years of clinical experience in an acute care setting desired. 1 year experience in managed care health plan required. Minimum 3 years' experience in a lead or supervisory role required. Long Term Care experience required. SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE): Case Manager Certification desirable. Experience providing case management/utilization management services. Managed care experience preferred (MCP, HMO or IPA). Excellent verbal and written communications skills. Knowledge of Medi-Cal regulations; MediCare a plus. Strong case management, utilization management, quality management, and care coordination background and skills. Ability to motivate and train. Knowledge of and experience with community and other resources (i.e., Regional Centers and CCS). Ability to communicate well with members, providers, and team members. Ability to prioritize workload. Experience in use of Windows including Microsoft Office suite. Experience in use of CM/UM Software applications. MCG, Managed Care and DHCS/NCQA experience preferred. SALARY RANGE $121,730.28-$182,595.42 Annually The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.