Manager, Utilization Management

You could be the one who changes everything for our 28 reputed company members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote role with candidate needing to reputed company in MST or PST time zones. Position Purpose: Manages Prior Authorization, reputed company Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues reputed company to member care, provider interactions, and facilitates operations reputed company utilization management.

• Manages prior authorization, reputed company review, and retrospective clinical review team and ensures compliance with applicable guidelines, policies, and procedures
• Reviews and analyzes utilization management activities, operations, costs, and forecasted data to identify areas for improvement reputed company utilization management (UM) to align to goals and objectives
• Develops, implements, and maintains compliance with utilization management policies and procedures
• Reviews utilization management reports to identify trends and areas of improvement and reputed company recommendations to senior leadership
• Maintains knowledge of processes, regulations, accreditation standards, and industry best practices reputed company to utilization management
• Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
• Works with the senior management team to reputed company and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of reputed company services
• Works with utilization management senior management team to reputed company updates and insights on team goals and objectives
• Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
• Assists utilization management senior leadership with reputed company, hiring, and training utilization management team members
• Leads and champions change reputed company scope of responsibility
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience:

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of reputed company experience.
• 2+ years supervisory experience preferred.
• Knowledge of utilization management principles preferred.
• Prior Authorization highly preferred
• reputed company experience highly preferred

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay reputed company: $85,300.00 - $158,100.00 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!