RN Manager - Utilization Management

Elevance Health•Brainerd, MN

12h•Onsite

About The Position

$5000 Sign on Bonus Location: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in-person interaction, communication, and immediate support Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. This position requires travel to our Washington, D.C. office 4 days each week. The office is located at 609 H. Street NE. The RN Manager - Utilization Management is responsible for managing a team of physical health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity. Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may include but are not limited to: Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan. Ensures continued compliance with specific medical management standards. Engages in the development process for medical and clinical management policy, procedures, and strategies. Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies. Hires, trains, coaches, counsels, and evaluates performance of both UM Assists and provides back up coverage to Case Management team

Requirements

BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.

Nice To Haves

Masters in related Health/Nursing field preferred.
3 years management experience with direct reports.
Managed Care Utilization Management experience, preferably in the District.
Working knowledge of clinical operations areas including regulatory and accreditation, compliance and quality management.
Must have prior utilization management leadership experience

Responsibilities

Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
Ensures continued compliance with specific medical management standards.
Engages in the development process for medical and clinical management policy, procedures, and strategies.
Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies.
Hires, trains, coaches, counsels, and evaluates performance of both UM Assists and provides back up coverage to Case Management team