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Utilization Management Director (RN)

Job Description

                                                                $5,000 SIGN-ON BONUS!!!

                                                      Full-time, Monday-Friday, 8:30am-5:30pm

Utilization Management Director (RN) develops, coordinates and directs the clinical and operational activities that are directly associated with the utilization management of medical services provided to Facey patients.  The Director is accountable for the compliance and efficiency measures of the UM Department for all lines of business and all functional areas.  Oversees complex case management and special needs population interventions and other Facey-wide clinical activities focused on management of over and underutilization of services using a set of metrics and industry standards. Develops and maintains constructive working relationships with providers,  health plans , hospitals and regulatory agencies.

 

 

Job Requirements

BSN or BA or BS degree in healthcare related field preferred.  Current California RN License and American Heart Association BLS for Healthcare Providers required.  Clinical understanding of hospital and ambulatory patient care delivery systems required. Minimum 5 years experience in utilization management, discharge planning, ambulatory case management, quality management or clinical area in a managed care setting, preferably a health plan or medical group with 2 years in a management role. Demonstrated knowledge of operations and managed care operations. Knowledge of California Health and Safety Act, NCQA, DMHC, CMS and DHS regulations. Demonstrated strong oral and written communication, problem-solving and analytical skills as related to Utilization data and analysis. Strong computer skills with MS Outlook, Word, Excel, use of Electronic Health Record and UM software for complex case management or utilization authorization /denial.

Our compensation package includes competitive pay, excellent benefits starting date of hire, generous paid time off, tuition reimbursement, 403(b) retirement plan with employer match, paid licensure & CEUs.   $5,000 Sign-On Bonus   



For immediate consideration, apply on-line at:   www.facey.com 

 

We are located at:

 

Facey Medical Foundation

Human Resources Department

15455 San Fernando Mission Blvd., Suite 100

Mission Hills, CA 91345

(818) 837-5655

 

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Management
Education Not Specified
Experience At least 2 year(s)
Manages Others Yes
Required Travel Negligible
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