Utilization Management Manager - Concurrent Review (RN)

We have an opportunity to join the Alliance as the Utilization Management Manager - Concurrent Review (RN) leading the Utilization Management - Concurrent Review Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Utilization Management Director, this position: 

• Plans, organizes and manages the Utilization Management Unit with focus on Concurrent Review
• Performs program effectiveness evaluation
• Manages, supervises, mentors and trains assigned staff
• Provides leadership in Health Services programs, operations, projects, policies and procedures and departmental operations

ABOUT THE TEAM

Our mission is to optimize members’ healthcare outcomes through evidenced-based clinical management, stewardship, and collaboration with provider and community partners. We determine medical necessity and benefit coverage for our members based on industry standards.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here. 

• Knowledge of:
  • Principles, practices, tools and techniques used in clinical nursing
  • Principles and practices of supervision and training
  • Principles and practices of utilization management
  • Research, analysis and reporting methods
  • Project management
  • Knox Keene, Medi-Cal, CMS, D-SNP, Title 22 and related regulations
• Ability 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
  • Evaluate medical records and other health care data
  • Act as a technical resource and explain regulations, processes, and programs related to area of assignment
  • Plan, develop, manage, coordinate, improve, implement and evaluate programs, projects, systems, activities and work plans
• Education 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, which included one year of utilization management, one year of case management experience, and a minimum of three years of supervisory experience related to supervising and training clinical staff (an Associate’s degree and two additional years of experience may substitute for the Bachelor’s degree); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

OUR BENEFITS

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 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 US

We 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. 

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.

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.