Manager Utilization Review Case Management

1 month ago

San Jose CA United States Bileddo Associates Full time

Manager of Utilization Review/Case Management

Silicon Valley near San Jose

One of CA's most desirable communities in the heart of Silicon Valley

America's leading nonprofit integrated health plan, my client serves more than 9 million people from 35 hospitals and 431 medical office buildings in nine states and the District of Columbia. Thanks to the dedication of approximately 180,600 employees and physicians, in a single year they may schedule more than 36 million outpatient visits, deliver 91,000 babies, perform 547,000 surgeries, and fill some 129 million prescriptions.

One of their showcase hospitals boasting over 260+ licensed beds has an immediate opening for a rock start Manager for their busy UA Department.

This position develops, coordinates and manages the administrative and operational activities that are directly associated with the utilization management of medical services provided to patients. Works independently; establishes priorities for staff.

Other duties include:

Chairs and Co-chairs local committees focused on creating, implementing and monitoring work plans to achieve UM targets and performance improvement. Provides expertise into target setting processes. Shares accountability with other medical center leadership for the daily monitoring of utilization indicators and performance, identification and escalation of problems, and initiation and evaluation of action plans for achieving medical center targets and improve the quality of care and services. Participates and provides UM expertise on local and regional committees, including UM Peer, UM Chiefs/Directors, Quality, other departments and contracted/planned providers. Manages projects related to chart reviews.

Conducts utilization data analysis (avoidable days, readmissions, UMAB, PRS reports, one-day stays, DRGs, LOS, PDRs, etc.) for trending and development of performance improvement initiatives. Partners with the UM Chief and local medical center leadership, to engage the following areas in the development and implementation of a comprehensive utilization management work plan to meet or exceed medical center targets: Physicians, managers across the continuum, and service leaders and managers. May include oversight of the coordination of KP members' care with leaders responsible for UM activities associated with alliance/contract hospitals and networks.

Experience

  • Three (3) or more years of experience in management /leadership in a hospital or outpatient setting.
  • Minimum three (3) years of previous experience in utilization management activities required.

Education:

  • Graduate of accredited school of nursing.
  • BSN or BA in health care related field OR four (4) years of experience in a directly related field required.

License, Certification, Registration:

  • Current California RN licensure.

Demonstrated strong interpersonal communication skills.

My client offers an aggressive compensation package (150-165K), amazing work/life balance, and the following benefits:

  • Generous vacation, holiday, and sick leave
  • Medical care (including prescriptions), vision, mental health, and dental car
  • Disability and life insurance coverage
  • Educational opportunities and tuition reimbursement
  • Employee assistance programs
  • Health care, dependent care and transit spending account options
  • Retirement plans

For prompt and confidential consideration, please apply to the link below:

Click here to apply online

WHAT CANDIDATES SAY ABOUT THIS RECRUITER:
'Anthony did a fine job in matching my skills with appropriate job opportunities. Anthony kept me posted regarding interview feedback. He made sure the job opportunity matched my skills and what I was looking for in the job market.'
Director-level Healthcare Candidate

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