Healthcare Utilization Manager

3 days ago

Sacramento, California, United States DirectEmployers Full time

At DirectEmployers, we are seeking a skilled and experienced Healthcare Utilization Manager to join our team. As a key member of our team, you will play a vital role in ensuring the quality and cost-effectiveness of healthcare services for our members.

The ideal candidate will have a strong background in nursing, with at least 3 years of experience in hospital acute care or medical settings. You will be responsible for assessing inpatient services to ensure optimal outcomes, cost-effectiveness, and compliance with state and federal regulations.

Key responsibilities will include analyzing clinical service requests, identifying appropriate benefits and eligibility, and conducting inpatient reviews to determine financial responsibility for our organization and its members. You will also be responsible for processing requests within required timelines, referring cases to medical directors, and collaborating with multidisciplinary teams to promote a high-quality care model.

We offer a competitive benefits and compensation package, including an estimated salary of $45.63 per hour based on your experience and qualifications. If you are a motivated and detail-oriented individual with a passion for delivering high-quality healthcare services, we encourage you to apply for this exciting opportunity.

Job Requirements:

  • Graduate from an accredited school of nursing
  • 3+ years of hospital acute care or medical experience
  • Active, unrestricted state registered nursing (RN) license in good standing
  • Valid driver's license with good driving record and ability to drive within applicable state or locality

Preferred Qualifications:

  • Bachelor's degree in nursing
  • Recent hospital experience in ICU, medical, or ER unit
  • Active, unrestricted utilization management certification (CPHM)

Why Work with Us:

At DirectEmployers, we are committed to providing our members with high-quality healthcare services that are medically appropriate and cost-effective. We offer a dynamic and supportive work environment, with opportunities for professional growth and development. If you are a motivated and detail-oriented individual with a passion for delivering high-quality healthcare services, we encourage you to apply for this exciting opportunity.

Location: Remote position, with the ability to work from home in the United States.

Work Schedule: 5 days per week, daytime work schedule (8:30 AM to 5:30 PM Pacific Time) with some weekends and holidays.

Apply Now: If you are interested in applying for this position, please submit your resume and cover letter to our online application portal.

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