Project Manager, Utilization Management

Regal Medical Group•Los Angeles, CA

10d

About The Position

The Project Manager is responsible for managing targeted programs and leading key projects to support standardization and/or process improvement activities related to department. In this role, the Project Manager will collect and analyze data to identify high value opportunities and prioritize, organize, plan, track and coordinate the implementation of approved projects. They will assure feedback loops are established to measure and report the effectiveness of programs and intervention and implement modifications/enhancements as appropriate.

Requirements

Bachelor’s degree required. Master’s Degree strongly preferred.
2-3 years project management or program development and management experience in a health care setting.
3-5 years’ experience in managed care environment required.
3- 5 years’ experience with Prior Authorizations & Utilization Management required.
Demonstrated success leading groups and resolving conflicts.
Experience working with all levels of management.
Required to travel for provider office visits and to regional offices.
Requires current CA driver’s license and car insurance

Responsibilities

Works collaboratively with campus medical directors, managers and staff working in concurrent review/Vital Care management/Prior Authorization Departments. Monitors and analyzes UM protocols and identifies trends and makes recommendations and develops programs and interventions to improve management.
Develops and coordinates strategies, in collaboration with the campus Medical Director, for ensuring the delivery of care in the most cost effective setting. (i.e. hospitals)
Oversees campus medical management operations, works with staff including concurrent review, prior authorization and vital care staff in order to achieve company goals and metrics.
Interprets and analyses campus utilization and budget reports for campus medical director.
Works cooperatively and collaboratively with the executive team as well as the campus medical director.
Coordinates or performs campus project/activities as delegated.
Monitors and analyzes UM protocols and identifies trends and makes recommendations and develops programs and interventions to improve outpatient budget as well as processes.
Identifies opportunities for the development and implementation of new approaches that improve efficiencies and production while maintaining quality.
All other duties as directed by management.