Manager, UM Regulatory

Found in: beBee S US - 2 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time
What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management Out-Patient Operations departmental clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities (e.g., Prior Authorization, UM Call Center operations). This position will also oversee delegate clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities. This role is responsible for the oversight/generation of all Utilization Management preservice regulatory correspondence including delivery and content. This role will assist the Director, UM Operations with the implementation and revision of policies and standards. This role requires collaboration and communication with various departments that share Utilization Management functions. This role will inspire and influence the team towards cultural transformation of the department through continuous improvement.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Experience

Five (5) or more years of experience in utilization management in a health care delivery setting. Three (3) or more years of supervisory experience with project management and team building experience essential. Working experience with State and Federal requirements (DHCS, CMS, DMHC) and quality standards (NCQA). Supervision can include managing projects and leading the participants of the project to successful implementation. Experience with training/mentoring newer Team Members. Organizing a workgroup to drive the successful implementation of a major program or process. Experience with Commercial Plan Coverage required.
Bachelor’s degree in related field from an accredited institution required.
Candidate with an active, unrestricted, and unencumbered Registered Nurse (RN) issued by the California BRN without a Bachelor’s degree will require four (4) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above.
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.
Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
Understanding and sensitivity to a multi-cultural environment and community.

Key Qualifications

State and federal requirements and regulations of CMS, DHCS, DMHC, and NCQA.

All aspects of managed care operations with extensive knowledge of HMO and IPA operations with an emphasis on Utilization/ Case Management and program development. Commercial managed care coverage.

ICD-10 and CPT/HCPC codes.

Start your journey towards a thriving future with IEHP and apply TODAY

  • Manager, UM Regulatory

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management...

  • Supervisor, UM Regulatory

    1 week ago

    Rancho Cucamonga, United States CareerBuilder Full time

    What You Can You Expect? Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! As the Supervisor, UM Regulatory & Compliance, you play a pivotal role in ensuring the success, productivity, and regulatory compliance for Prior Authorization...

  • Supervisor, UM Regulatory

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    Overview: What You Can You Expect? Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! As the Supervisor, UM Regulatory & Compliance, you play a pivotal role in ensuring the success, productivity, and regulatory compliance for Prior...

  • Analyst I

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    **What you can expect!** Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience!** Under the direction of the Manager, Regulatory Affairs, the Analyst I - Regulatory Affairs (Policy & Communications) has a general knowledge of and...

  • Analyst II

    11 hours ago

    Rancho Cucamonga, United States IEHP Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department....

  • Analyst II

    Found in: Appcast Linkedin GBL C2 - 1 week ago

    Rancho Cucamonga, United States IEHP Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department....

  • Analyst II – Regulatory Affairs – Medi-Cal

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department....

  • Analyst II

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plans Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance...

  • Analyst II – Regulatory Affairs – Medi-Cal

    2 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department....

  • Analyst II – Policy

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Analyst II - Policy & Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap...

  • Regulatory Production Specialist II

    Found in: Resume Library US A2 - 1 week ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Overview: What you can expect!    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!   The Regulatory Production Specialist II will be responsible for managing day-to-day operations of a portfolio of regulatory member...

  • Manager, ECM Transitional Care

    Found in: Resume Library US A2 - 1 week ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Overview: What you can expect!    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!   Under the direction of the ECM Director, the Manager, ECM Transitional Care is responsible for day-to-day management of clinical and...

  • Analyst I

    Found in: Resume Library US A2 - 1 week ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Overview: What you can expect!    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!   Under the direction of the Manager, Regulatory Affairs, the Analyst I - Regulatory Affairs (Policy & Communications) has a general...

  • Operations Compliance Manager

    19 hours ago

    Rancho Cucamonga, United States Citizens Business Bank Full time

    Exact compensation may vary based on skills, experience and/or education, and location. This position is also eligible for an annual bonus.**GENERAL PURPOSE OF THE JOB**: Under general direction, oversee the Bank’s Operations and Trust Compliance Programs to identify, measure, control and monitor compliance risk. **ESSENTIAL DUTIES AND...

  • Managed Care Counsel

    12 hours ago

    Rancho Cucamonga, United States Robert Half Full time

    DescriptionIn House Counsel Opportunity for Large Healthcare Organization!You will be joining a large legal team and a Managed Care expert (Medical, Medicaid, Covered CA). You will manage outside counsel for discovery and litigation, advise on regulatory and compliance issues, and HIPAA advisor.This Counsel is onsite 3 days per week (Tuesday-Thursday). The...

  • Medical Director

    5 days ago

    Rancho Cucamonga, United States IEHP Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in 'healing and inspiring the human spirit' and to pivot from a 'job' opportunity to an authentic experience!The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral health...

  • Medical Director

    Found in: beBee S US - 1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Medical Director

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Associate Counsel, Manager

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Under the direction of Legal Department leadership, the Associate Counsel will be responsible for legal research and advice to support the organization’s...

  • Audit Manager

    1 week ago

    Rancho Cucamonga, United States Regal Executive Search Full time

    Job Description AUDIT MANAGER The Audit Manager works closely with Partners and clients to facilitate orderly completion of engagements. The Audit Manager is also responsible for reviewing work papers, preparing client files for partner review, interfacing with client executives and providing the final audit documents to clients for distribution. MINIMUM...