Manager, Utilization Management Nurse Management (MediCare Concurrent

Your Role

The Utilization Management Concurrent Review team ensures accurate and timely authorization of designated healthcare services clinical review determinations for Medicare Line of Business. The Manager, Utilization Management Nurse Management will report to the Director, Utilization Management Nurse 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 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 and cost in collaboration with department Director

Participate in the development and implementation of the annual budget under the direction of department Director

Ensure workflow procedures and guidelines are clearly documented and communicated

Interpret or initiate changes in guidelines/policies/procedures

Manage multiple regulatory reports

Establish and manage operational reports

Ensure regulatory and accreditation standards are met for Medicare of business

Collaborate across functionally to improve member outcomes

Participate in Regulatory and Internal Audits

Your Knowledge and Experience

Requires a bachelor's of science in nursing 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 Advantage and DSNP)

Requires strong emotional intelligence skills

Requires the ability to work collaborative with cross functional operations

Full Time