Manager, Utilization Management Nurse Management (...

Your RoleThe Utilization Management Prior Authorization team ensures accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Manager, Utilization and Medical Review will report to the Director, Utilization and Medical Review. 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 WorkIn 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 Sr Manager / DirectorParticipate 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 Manage multiple regulatory reportsEstablish and manage operational reportsEnsure regulatory and accreditation standards are met for multiple lines of businessCollaborate across functionally to improve member outcomesParticipate in Regulatory and Internal AuditsYour Knowledge and ExperienceRequires a bachelor's Degree or equivalent experienceRequires a current California RN LicenseRequires at least 7 years of prior relevant experience including 3 years of management experienceHas demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegationRequires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, ASO/SA, IFP, Medicare Advantage)Requires strong emotional intelligence skillsRequires the ability to work collaborative with cross functional operations

Created: 2025-02-24