Utilization Management Manager II

CareBridge • Washington, DC

84d • $115,092 - $172,638

About The Position

The Utilization Management Manager ll 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. This position requires travel to our Washington, D.C. office 4 days each week. The office is located at 609 H. Street NE.

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

• Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations.
• 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.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees