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Utilization Management Manager - Authorizations

Company: Central California Alliance for Health
Location: Antioch
Posted on: November 19, 2022

Job Description:

We have an opportunity to join the Alliance as the Utilization Management Manager - Authorizations (RN) leading in the Utilization Management and Complex Case Management Department.
We have one position in either our Merced, Salinas or Scotts Valley, California office, or remote in the United States.

WHAT YOULL BE RESPONSIBLE FORReporting to the Utilization Management Director, you will manage and lead the Utilization Management (UM) Prior Authorization, Authorization Coordinator, and Non-Emergency Medical Transportation teams, acts as a subject matter expert, and provide guidance related to utilization management activities and departmental operations. You will perform program effectiveness evaluation. You will manage, supervise, mentor and trains assigned staff and provide leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results
ABOUT THE TEAMWe determine medical necessity and benefit coverage for our members based on industry standards.
WHAT YOULL NEED TO BE SUCCESSFULTo read the full position description, and list of requirements please click here. Knowledge of:

  • The principles, practices, tools and techniques used in clinical nursing
  • The principles and practices of utilization management and complex case management
  • The principles and practices of supervision and training
  • Research, analysis and reporting methods
  • Project management
  • Knox Keen, Medi-Cal, Title 22 and related regulationsAbility to:
    • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation and motivate staff to achieve goals and objectives
    • Organize and prioritize the work of others, delegate authority and responsibility and follow up on work assignments
    • Analyze and interpret legal, regulatory and contractual language, policies, procedures and guidelines, and legislative and regulatory directives
    • Act as a technical resource and explain regulations, processes and programs related to area of assignmentEducation and Experience:
      • Current unrestricted license as a Registered Nurse issued by the State of California
      • Bachelor's degree in Nursing and a minimum of six years of experience in a health plan or patient care setting, which included a minimum of three years of utilization management experience and one year of case management experience and a minimum of three years of experience supervising and training clinical staff (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
        • While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
        • Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
        • Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

          COVID-19 Vaccine Requirement: This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.
          OUR BENEFITS
          • Medical, Dental and Vision Plans
          • Ample Paid Time Off
          • 11 Paid Holidays per year
          • 401(a) Retirement Plan
          • 457 Deferred Compensation Plan
          • Robust Health and Wellness Program
          • Onsite EV Charging Stations
          • And many more
            ABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
            Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties.

            At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Keywords: Central California Alliance for Health, Antioch , Utilization Management Manager - Authorizations, Executive , Antioch, California

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