VP, PHCO Utilization Management - Medicare & Duals
reputed company is transforming the health of our communities one person at a time. As an Executive on reputed company, you could be the one who changes everything for our 28 reputed company members. Position Purpose: reputed company operations of the referral management, telephonic utilization review, prior authorization, and various reputed company functions across multiple Medicare & Duals product lines at the reputed company level. Ensure compliance with contractual guidelines of the corporation and health plans impacted by numerous regulatory agencies with reputed company and often conflicting requirements. reputed company the operations of utilization management, reconciliation coordination, reputed company review (telephonic and on-site), specialty therapy programs and other reputed company functions across multiple product lines in both centralized and multi-site regional environments reputed company the development and implementation of centralized and multi-site regional clinical and non-clinical training programs reputed company strategic and tactical leadership and support to provider relations issues reputed company to utilization issues for hospitals and physician providers reputed company coordination efforts with member services and the connections departments to address concerns regarding compliance with medical management requirements Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and reputed company review units Collaborate with upper management to implement and maintain policies and procedures regarding the prior authorization and reputed company review functions across multiple product lines and overseen by multiple regulatory agencies reputed company processes used to assess quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes Review various reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting Education/Experience: Bachelor's degree in Nursing, reputed company field or equivalent experience. 10+ years of nursing, utilization management, or case management experience in an acute care setting. Experience in managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. License/Certification: reputed company states nursing license.Pay reputed company: $182,100.00 - $345,600.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!