Manager, Utilization Management Nurse Management
About The Position
The Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. The Utilization Management Manager will report to the Director of Utilization Management. In this role you will lead and support a team of clinicians to ensure safe, timely, and appropriate care for members. You will apply advanced clinical knowledge and proven management skills to organize work, coach staff, and manage risk. Your leadership helps drive consistent, high-quality utilization management outcomes. 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.
Requirements
- Requires maintaining an active, unrestricted RN license in assigned states or the ability to obtain required state (in addition to primary state license) RN license within 90 days of hire
- Requires 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor or project/program manager
- Requires knowledge of regulatory requirements for government lines of business (Medi-Cal and Medicare)
- Strong emotional intelligence skills
- Strong communication and computer navigation skills
- Strong teamwork and collaboration skills
- Strong critical thinking skills
- Independent motivation and strong work ethic
Nice To Haves
- Bachelor of Science in Nursing or advanced degree preferred
Responsibilities
- Establish operational objectives for department or functional area and participate with other managers to establish group objectives
- Be responsible for team, department, or functional area results in terms of planning, cost; in collaboration with department Director
- Participate in the development and implementation of the annual budget under the direction of Sr Manager / Director
- Ensure workflow procedures and guidelines are clearly documented and communicated
- Interpret or initiate changes in guidelines/policies/procedures
- Establish and manage operational and regulatory reports
- Ensure regulatory and accreditation standards are met for Medicare, and Medi-Cal lines of business
- Collaborate across functional departments to improve member outcomes
- Participate in regulatory and internal audits as applicable
- Support and facilitate staff meetings, clinical rounds, and weekly huddles
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
