RN Director Utilization Management

1 day ago

Bakersfield, United States CommonSpirit Health Full time

Overview:

***This position is remote within California, Nevada or Arizona, with a clear and current CA RN license.

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Healths Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities:

***This position is remote within California, Nevada or Arizona, with a clear and current CA RN license.

Position Summary:


The Director of Utilization Management is the senior lead over the utilization management nursing teams. They are responsible for the day-to-day operations of the UM nursing teams including preservice utilization review, concurrent inpatient review, and retro claim review. The UM Director is also responsible for the oversight of utilization management auditing, both internal and external, for all DHMSO service areas, as well as the development of UM work plans for submission to health plans as needed. They are the operational lead for bringing on new lines of business into the UM workflow. The Director is responsible for reviewing and providing program metrics to senior leadership, as well as analysis of program and utilization statistics, as well as delivering reporting to both UM and quality committee meetings. The Director has direct leadership over teams of managers and direct reports across the service area.

Qualifications:

Minimum Qualifications:


- 5 years progressive leadership experience in Care Management. Experience in developing and leading care coordination programs.
- Master's degree in nursing or equivalent experience required.
- Clear and current CA Registered Nurse (RN) license.
- Knowledge of federal, state and local healthcare related laws and regulations; ability to comply with these in healthcare practices and activities.
- Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way.
- Experience translating vision into a plan and executing the plan flawlessly.

#LI-DH

#carecoordination

#ccleaders

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