Job Information
Dignity Health RN Manager Utilization Management in Rancho Cordova, California
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
This position is hybrid in-office and work from home. Office space will be available in Rancho Cordova and Woodland.*
Please note: This position will involve rotating Saturday coverage.*
Position Summary:
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.
This position has oversight responsibility to plan, develop and direct the Utilization Management Department including the sections for authorizations and concurrent review. Develops and implements effective and efficient standards, protocols and processes; department decision support systems; and reports and benchmarks that support continual enhancement of utilization management functions and promote quality health care for members.
Qualifications
Minimum Qualifications:
Demonstrated track record in managed care (5+ years experience preferred).
BSN/BS/BA and/or Masters Degree in Healthcare related field.
Clear and current CA RN license
Strong supervisory and management skills.
Excellent verbal and written communication and computer skills.
Considerable interpersonal skills.
Preferred Qualifications:
Clinical claims review experience highly desired.
Knowledge of relevant State and Federal laws statutes and regulations preferred.
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Pay Range
$51.66 - $74.91 /hour
We are an equal opportunity/affirmative action employer.