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RN Director, Utilization Management

In United States

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RN Director, Utilization Management   

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JOB TITLE:

RN Director, Utilization Management

JOB TYPE:

JOB SKILLS:

JOB LOCATION:

Sacramento, CA | Woodland Hills, CA United States

JOB DESCRIPTION:

You could be the one who changes everything for our 26 million members. Our client is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Direct medical management program including utilization management, case management, quality improvement and credentialing in accordance with the mission, philosophy, and objectives of plan and in conjunction with Corporate goals and objectives.

  • Develop department objectives and organize activities to achieve objectives.
  • Evaluate and implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies.
  • Manage budget and forecast for strategic planning and key initiatives.
  • Coordinate with operating departments on research and implementation of best practices.
  • Responsible for the statistical analysis of utilization data on programs.
  • Participate in NCQA, State, and/or other accreditations of the Plan.
  • Organize and present new concepts, programs and tools to staff and other plan departments.
  • Develop communication plans with external providers such as hospitals and State agencies as required to facilitate plan goals and objectives.
  • Coordinate with Medical Director to educate and communicate expectations with providers.
Qualifications:


Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing, quality improvement, and management experience in a healthcare environment, preferable managed care. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

License/Certification: RN license.

 

Benefits 

Our Comprehensive Benefits Package:

  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  • Competitive pay
  • Paid Time Off including paid holidays
  • Health insurance coverage for you and dependents
  • 401(k) and stock purchase plans
  • Tuition reimbursement and best-in-class training and development


For Western Sky Community Care:
Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing, quality improvement, and management experience in a healthcare environment, preferable managed care. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

License/Certification: Current state's RN or LMSW license.

For North Carolina only:
License/Certification: Current RN or LCSW license.

For Iowa Total Care: Candidates with active RN license in good standing in states other than IA, must obtain the IA RN equivalent within 90 days of hire.

Our client is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Employee Status:
Regular
Job Level:
Director/Sr. Director
Job Type:
Regular

Position Details

POSTED:

Sep 27, 2022

EMPLOYMENT:

INDUSTRY:

SNAPRECRUIT ID:

S16528320319572973

LOCATION:

United States

CITY:

Sacramento, CA | Woodland Hills, CA

Job Origin:

OORWIN_ORGANIC_FEED

A job sourcing event
In Dallas Fort Worth
Aug 19, 2017 9am-6pm
All job seekers welcome!

RN Director, Utilization Management    Apply

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<div> <p>You could be the one who changes everything for our 26 million members. Our client is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.<br /> </p> <p>Position Purpose: Direct medical management program including utilization management, case management, quality improvement and credentialing in accordance with the mission, philosophy, and objectives of plan and in conjunction with Corporate goals and objectives.<br /> </p> <ul> <li>Develop department objectives and organize activities to achieve objectives.</li> <li>Evaluate and implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies.</li> <li>Manage budget and forecast for strategic planning and key initiatives.</li> <li>Coordinate with operating departments on research and implementation of best practices.</li> <li>Responsible for the statistical analysis of utilization data on programs.</li> <li>Participate in NCQA, State, and/or other accreditations of the Plan.</li> <li>Organize and present new concepts, programs and tools to staff and other plan departments.</li> <li>Develop communication plans with external providers such as hospitals and State agencies as required to facilitate plan goals and objectives.</li> <li>Coordinate with Medical Director to educate and communicate expectations with providers.</li> </ul> <h5 class="m-t-lg m-b-xs"><strong>Qualifications:</strong></h5> <p><br /> Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing, quality improvement, and management experience in a healthcare environment, preferable managed care. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.<br /> <br /> License/Certification: RN license.</p> <p> </p> <p>Benefits </p> <p>Our Comprehensive Benefits Package:</p> <ul> <li>Flexible work solutions including remote options, hybrid work schedules and dress flexibility</li> <li>Competitive pay</li> <li>Paid Time Off including paid holidays</li> <li>Health insurance coverage for you and dependents</li> <li>401(k) and stock purchase plans</li> <li>Tuition reimbursement and best-in-class training and development<br /> </li> </ul> <p><br /> For Western Sky Community Care:<br /> Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing, quality improvement, and management experience in a healthcare environment, preferable managed care. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.<br /> <br /> License/Certification: Current state's RN or LMSW license.<br /> <br /> For North Carolina only:<br /> License/Certification: Current RN or LCSW license.<br /> <br /> For Iowa Total Care: Candidates with active RN license in good standing in states other than IA, must obtain the IA RN equivalent within 90 days of hire.<br /> <br /> <i>Our client is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.</i></p> <h5 class="m-t-lg m-b-xs"><strong>Employee Status:</strong></h5> Regular <h5 class="m-t-lg m-b-xs"><strong>Job Level:</strong></h5> Director/Sr. Director <h5 class="m-t-lg m-b-xs"><strong>Job Type:</strong></h5> Regular</div>


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