Manager - Utilization Management Nurse Management

Your Role

The Utilization Management team reviews inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care for our Shared Services department including concurrent review, transplant and NICU/HROB. The Manager, Utilization Management Nurse Management will report to the Director, Utilization Management. In this role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiatives. 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.

Your Knowledge and Experience

• Requires a bachelor's Degree or equivalent experience 
• Requires a current California RN License 
• Requires at least 7 years of prior relevant experience including 3 years of management experience
• Has demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
• Requires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, Medicare, and Commercial)
• Requires strong emotional intelligence skills
• Requires the ability to work collaborative with cross functional operations
• Requires at least 2 years of prior relevant experience in transplant utilization management review

Your Work

In this role, you will:

• 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 work flow 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 all lines of business including Commercial, Medicare, and Medi-Cal
• 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