Care Coordination Executive

3 weeks ago


Rancho Cordova, California, United States Blue Shield of California Full time

About the Job:

We are seeking an experienced Director, Commercial Utilization Management to join our team at Blue Shield of California. This role offers the opportunity to make a meaningful impact on the lives of our members by ensuring they receive high-quality, cost-effective care.

Responsibilities:

  • Develop and implement utilization management strategies that align with our clinical policies and goals.
  • Lead teams of professionals to review and authorize medical services, ensuring that they are medically necessary and meet our quality standards.
  • Analyze data to identify trends and patterns in healthcare utilization, and develop reports and recommendations to inform our utilization management decisions.
  • Partner with physicians and other healthcare providers to develop effective care coordination strategies and improve patient outcomes.
  • Manage operational teams and resources to ensure efficient and effective delivery of utilization management services.
  • Stay up-to-date with regulatory requirements and industry developments, and ensure that our utilization management practices comply with all relevant laws and regulations.

Requirements:

  • Minimum 10 years of experience in utilization management or a related field, including 6 years of management experience.
  • Bachelor's degree in nursing or a related field, Master's degree or equivalent experience preferred.
  • Current RN license in California required.
  • Strong analytical and problem-solving skills, with ability to analyze complex data and develop actionable recommendations.
  • Excellent communication and interpersonal skills, with ability to work effectively with diverse stakeholders, including physicians, patients, and other healthcare professionals.
  • Experience with health plan operations and regulatory compliance a plus.

Pay Range:

The estimated salary for this role is $165,990 - $248,930 per year, based on your location (California) and experience.


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