Clinical Utilization Management Manager

3 weeks ago

Ontario, United States Calibrated Healthcare Full time

**Company Information**:
Calibrated Healthcare is a Business Process Outsourcing (BPO) company providing healthcare administration and administrative support for medical management for its clients in the Healthcare industry. Headquartered in Ontario, California, we currently have offices in India and the Philippines providing various administrative services to our clients.

**General Summary**

The Clinical Utilization Management (UM) Manager is responsible for overseeing Utilization Review and Case Management to promote quality, cost effectiveness medical care through strict adherence to all UM policies and procedures within the affiliated IPA for which this position has oversight. The Manager coordinates, plans, and manages staff activities; develops program goals and objectives with the Director of Health Services and Medical Director. Together with the medical director, interprets and administers pertinent laws; through direct and indirect contact. The manager represents the department in meetings of professional and/or community organizations. This position requires general knowledge of CMS and California Department of Managed Health Care (DMHC)) Utilization Management processes/policies/procedures and timeliness standards.

**Essential Functions**
- Must have working knowledge of MS Office environment, and ability to function in highly computerized environment.
- The Manager makes staff assignments. Evaluates staff and determines the quality of their work efforts.
- Develops or assists in the development of related prior authorization and claims policy, incorporating current literature and professionally recognized standards.
- Develops or assists in development and implementation of policy and plans for effective patient centered utilization management and case management.
- Develops and/or implements effective ongoing programs to measure, assess, and improve quality of processes and workflows, treatment, and services delivered to patients.
- Develops productive work teams; recommends disciplinary actions; collaborates with clinical leadership for educational programs. compiles data and prepares periodic reports; responsible for coordinating and providing appropriate coverage.
- Maintains contacts with individuals both within and outside of the department who might impact program activities.
- Assures optimal quality of care and service is provided.
- Participates in Quality Assurance Programs as needed; intervenes in crisis situations and investigates all unusual incidents.
- Leads and participates in meetings; may speak on behalf of department.
- Management level experience including but not limited to: staff oversight, program management, and issue resolution.

**Education**
- Graduate of an accredited Registered Nursing or Licensed Vocational Nursing Program.

**Experience**
- Minimum of 5 years’ recent clinical experience.
- Minimum of 3 years’ experience in IPA or managed care setting preferred.
- Experience supervising staff and monitoring productivity/performance required.
- Prior experience with project development and implementation.
- Must have excellent communications skills both verbally and written.
- Project Management experiences a plus.

**Other Requirements**
- Active and unrestricted Registered Nursing license.

**Performance Requirements**
- Knowledge:_
- Knowledge of CMS and California Department of Managed Health Care (DMHC)).
- Knowledge of Utilization Management processes/policies/procedures and timeliness standards.
- Skills:_
- Skill in organizational, interpersonal and analytical thinking.
- Possess tact and diplomacy in interpersonal interactions.
- Abilities:_
- Ability to deal with responsibility with confidential matters.
- Ability to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
- Ability to be self-motivated and have high personal ethics.
- Requirements:_
- Employee required to lock work station every time they step away (Control, Alt, Delete)

**Equipment Operated**:Range of medical records, phones, faxes and other office supplies, including computer hardware/software.

**Work Environment**:Professional office setting. Well-lighted, well-ventilated, adequate space.

**Mental/Physical Requirements**:Involves sitting approximately 90 percent of the day, walking or standing the remainder.

**Benefits**:

- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Work Location: Hybrid remote in Ontario, CA

  • Clinical Utilization Management Manager

    3 weeks ago

    Ontario, California, United States Calibrated Healthcare Full time

    Company Information:Calibrated Healthcare is a Business Process Outsourcing (BPO) company providing healthcare administration and administrative support for medical management for its clients in the Healthcare industry. Headquartered in Ontario, California, we currently have offices in India and the Philippines providing various administrative services to...

  • Non-clinical Utilization Management Manager

    3 weeks ago

    Ontario, United States Calibrated Healthcare Full time

    **Company Information**: Calibrated Healthcare is a Business Process Outsourcing (BPO) company providing healthcare administration and administrative support for medical management for its clients in the Healthcare industry. Headquartered in Ontario, California, we currently have offices in India and the Philippines providing various administrative services...

  • Corporate Director of Clinical Utilization

    2 weeks ago

    Ontario, United States Prime Healthcare Management Inc Full time

    Overview: **_ Prime Healthcare_**_ is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians....

  • Corporate Director of Clinical Utilization Management

    3 weeks ago

    Ontario, California, United States Mission Regional Medical center Full time

    OverviewPrime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the...

  • Case Manager Utilization RN, 40/hr Day

    1 month ago

    Ontario, United States Kaiser Permanente Full time

    Sign On Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • Case Manager Utilization Rn, 40/hr Day

    4 weeks ago

    Ontario, United States Kaiser Permanente Full time

    **Sign on Bonus for Eligible External Hires** **Job Summary**: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • Utility Agent ONT

    1 week ago

    Ontario, United States TBI AIRPORT MANAGEMENT INC Full time

    Job DescriptionJob DescriptionDescription:Under general supervision, perform various basic level laborer duties including refuse collection, general cleaning, physical labor, weed abatement, basic facility maintenance, perform minor asphalt pavement repairs, applying protective and decorative coatings to structures, equipment and furniture; and assist senior...

  • Utility Agent ONT

    2 weeks ago

    Ontario, United States TBI AIRPORT MANAGEMENT INC Full time

    Job DescriptionJob DescriptionDescription:Under general supervision, perform various basic level laborer duties including refuse collection, general cleaning, physical labor, weed abatement, basic facility maintenance, perform minor asphalt pavement repairs, applying protective and decorative coatings to structures, equipment and furniture; and assist senior...

  • Utility Agent ONT

    3 days ago

    Ontario, United States TBI AIRPORT MANAGEMENT INC Full time

    Job DescriptionJob DescriptionDescription:Under general supervision, perform various basic level laborer duties including refuse collection, general cleaning, physical labor, weed abatement, basic facility maintenance, perform minor asphalt pavement repairs, applying protective and decorative coatings to structures, equipment and furniture; and assist senior...

  • Utilization Review Technician Iii

    4 weeks ago

    Ontario, United States Prime Healthcare Management Inc Full time

    Overview: Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of...

  • Utilization Review Technician Iii

    1 week ago

    Ontario, United States Prime Healthcare Management Inc Full time

    Overview: Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of...

  • Case Manager Utilization RN, 40/hr Day

    4 weeks ago

    Ontario, United States Kaiser Permanente Full time

    Sign on Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...

  • Manager, Clinical Faculty

    3 days ago

    Ontario, United States West Coast University Full time

    At West Coast University, we share a passion for students and transforming healthcare education! As an associate for a certified Great Place to Work, you will join a collaborative, student-centric culture valuing academic integrity, mutual respect, student learning, service, responsiveness, innovation, diversity, and stewardship.  As a part of this team,...

  • Manager, Clinical Faculty

    1 week ago

    Ontario, California, United States West Coast University Full time

    At West Coast University, we share a passion for students and transforming healthcare education As an associate for a certified Great Place to Work, you will join a collaborative, student-centric culture valuing academic integrity, mutual respect, student learning, service, responsiveness, innovation, diversity, and stewardship. As a part of this team, you...

  • Regional Operations Manager

    2 weeks ago

    Ontario, United States ES Management Group Inc Full time

    **Role and Responsibilities** Responsibilities include management of the assigned territory and the branches including the day-to-day management of branch managers. - Identify and hire internal employees as well as skilled and direct hire associates. - Will manage multiple offices for assigned region - Identify new business within the market, provide leads...

  • Epic Implementation Manager

    3 weeks ago

    Ontario, California, United States Prime Healthcare Management Inc Full time

    Career Opportunity: Epic Implementation Manager at Prime HealthcarePrime Healthcare, a prestigious healthcare system based in Ontario, California, is on the lookout for a new team member. With a network of 45 hospitals and over 300 outpatient locations across 14 states, Prime Healthcare serves more than 2.6 million patients annually. Join a dynamic team of...

  • Project Manager with Engineer Support

    3 days ago

    Ontario, United States DJ Acquisition Management Corp Full time

    Job DescriptionJob DescriptionDescription:Position SummaryThe Project Manager position will be responsible for management of high profile and complex projects from start to finish. This role will also work with employees on the shop floor to improve efficiency, safety, and quality of manufacturing processes.Duties and Responsibilities · Spearheads C.I.P. to...

  • Project Manager with Engineer Support

    1 month ago

    Ontario, United States DJ Acquisition Management Corp Full time

    Job DescriptionJob DescriptionDescription:Position SummaryThe Project Manager position will be responsible for management of high profile and complex projects from start to finish. This role will also work with employees on the shop floor to improve efficiency, safety, and quality of manufacturing processes.Duties and Responsibilities · Spearheads C.I.P. to...

  • Corporate Performance Improvement Manager

    2 weeks ago

    Ontario, United States Prime Healthcare Management Inc Full time

    Overview: Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of...

  • Assistant Manager

    4 weeks ago

    Ontario, United States Andasol Management, Inc. Full time

    **Who We Are?** Trojan Storage is the best self-storage operator in the business with over 40+ locations in the U.S today! Simply put, we have the best people in the workplace with our amazing culture, healthy benefits, and growth opportunities. **Your Benefits**: Full-Time schedules between 9:30AM to 5:30PM (weekends 10AM - 4PM) Medical, Dental, Vision,...