Health Plan Nurse Program Director

The Health Services Department is seeking to fill the vacancy of Health Plan Nurse Program Director in the Contra Costa Health Plan (Utilization Management) located in Martinez, CA. Under general direction the incumbent will plan, develop, organize and manage the day-to-day clinical programs, policies and services, participate in special assignments and study projects. Other responsibilities include patient care coordination, provide clinical direction and supervision to licensed personnel, ensure compliance with contractual, accreditation and regulatory requirements, develops and manages annual department goals, and coordinates department projects and activities to meet budgetary limits and timelines.

The ideal candidate will have a proven track record demonstrating the following:
Proven utilization management experience with Medi-Cal Managed Care and Medical Insurance Organizations
Extensive knowledge in regulatory audits (DHCS, DMHC and NCQA)
Experience in a unionized environment
Comprehensive knowledge of utilization management clinical guidelines, i.e. Medi-Cal, Apollo and Medicare
Characteristics of the ideal candidate:
Extensive experience in a health plan setting
Excellent clinical and ancillary staff supervisory experience
Excellent interpersonal skills
Ability to maintain effective County, public and internal relationships

Read the complete job description at The eligible list established from this recruitment may remain in effect for six months.

Position Description »