Manager of Utilization Management

San Leandro, California

Position Summary: Are you an experienced Registered Nurse with case management, utilization management and supervisory experience looking for a new opportunity with a prestigious healthcare company as a Manager of Utilization Management? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes” to any of these questions – this is the position for you!

Hours for this Position: Mon-Fri 8am-5pm

Advantages of this Opportunity:

• Competitive salary
• Fun and positive work environment
• Great benefits package

Required Skills

What We Look For:

• Active California Clinical License; RN license preferred; LVN/NP may be considered.
• 5+ years in Utilization Management / Quality Improvement in hospital, HMO, or IPA setting.
• 3+ years in health care delivery at hospital, clinic, or physician’s office.
• Familiarity with community health centers and the safety net setting is preferred.

Skills

• Excellent communication and customer relation skills
• Must be able to demonstrate and apply Change Management concepts
• Utilization Management/ Quality Improvement experience
• Flexibility and desire to innovate
• Management experience necessary
• Computer literacy
• Ability to analyze data to support decision-making
• Sound decision-making skills for clinical and non-clinical issues.
• Training skills.
• CDL required.

Responsibilities

More Insight of Daily Responsibilities: 

Embrace the organization’s commitment to a community health strategy and provide oversight and guidance the staff of the Outpatient Services Utilization Unit to support the strategy. Work with senior leadership team members to operationalize the vision for the Unit as an integral component to the organization’s strategic plan. Develop, update, review and provide oversight of processes, policies and procedures. Responsible for utilization management and quality reports, and all HMO contractual requirements related to outpatient services.

Essential Functions:

• Embrace the organization’s commitment to a community health strategy and align the processes and responsibilities within the unit with the strategy
• Provide guidance and oversight to staff of the Outpatient Service Utilization Unit such that they optimize the quality and efficiencies of their work to meet defined standards
• In partnership with senior leadership staff, develop, implement, refine and institutionalize innovative processes and procedures within the unit that represent best practices
• Establish a data driven culture across the unit that utilizes analytics to improve processes
• Work with internal and community partners to improve and secure access to outpatient services for CHCN assigned members
• Work collaboratively with all other areas within CHCN
• Maintain documents that define the policies and procedures within the unit that reflect current practice and meet all contractual and regulatory obligations
• Participate in the monthly Operation Management meeting and other meetings as appropriate
• Provide temporary cross-coverage for the Prior Authorization Nurses as necessary to meet turn-around-time standards
• Other duties as assigned.

Want More Information? Interested in hearing more about this great opportunity? Reach out to Aaron Hanshew at Ahanshew@healthcaresupport.com for immediate consideration. Interviews are being held as soon as possible! Click Apply Now for more information; we look forward to hearing from you!

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Salary

Based on Experience