Dignity Health

RN Manager, Utilization Management (UM)

Job ID
2017-38197
Employment Type
Full Time
Department
Utilization Review
Hours / Pay Period
80
Facility
Dignity Health Medical Group Region
Shift
Day
Location
RANCHO CORDOVA
Optional Work Location
US-CA-WOODLAND
CA
Standard Hours
Mon-Fri, 8-5

Overview

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

Responsibilities

Position Summary:

 

This position will travel regularly between Rancho Cordova, Sacramento and Woodland.

 

The Manager of Utilization Management (UM) is responsible for managing the day to day operation of Utilization Management Department and Prior Authorization (PA) teams, including hiring, scheduling, coaching, development and evaluation of employee performance. Analysis of available data to measure individual and team performance, clinical program performance, team processes and compliance are essential. Working with staff, the manager will anticipate and resolve complex issues to ensure accurate and cost effective operations and the achievement of productivity and quality metrics. 

 

Additionally, the Manager will work in conjunction with the Director of UM on a variety of critical tasks including the management of one or more focused clinical initiatives and representing the company externally in presentations with key provider and payer groups that integrate state and federal regulations to ensure compliance with regulatory requirements.

 

Core Duties:

  • Plan, develop, and direct the Utilization Management Department, including the sections for authorizations and concurrent review.
  • Develops and implements effective and efficient standards 
  • Develops and implements protocols and processes
  • Develops and implements department decision support systems
  • Reports and benchmarks that support continual enhancement of utilization management functions and promote quality health care for members 

 

Qualifications

Minimum Qualifications:

  • Bachelor degree (BSN/BS/BA) and/or Master's degree in a healthcare-related field required
  • Current California RN license required
  • Experience in Managed Care required
  • Requires:
    • Strong supervisory and management skills
    • Excellent verbal and written communication and computer skills
    • Considerable interpersonal skills.

 

Preferred Qualifications:

  • Five (5) years of experience in Managed Care preferred
  • Clinical claims review experience preferred
  • Knowledge of relevant State and Federal laws, statutes and regulations preferred.

 

 

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