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Utilization Management Nursing Manager

Location: El Monte
Posted on: June 21, 2022

Job Description:

Job descriptionSEEKING RN HIGHLY EXPERIENCED IN UTILIZATION MANAGEMENT (Signing Bonus Included)If you're an RN, that's tired of working weekends, nights, holidays, long shifts or having second thoughts of working in a hospital setting during a health crisis, this is a GREAT opportunity with Local 1014 (the trust Division for the Los Angeles County Fire Fighters). 1014 is seeking to hire a UR/UM nurse to manage our small Utilization Review department, as our current nursing manager will be retiring after 20 years of service with us. We are dedicated to serving the wellbeing of the Fire Fighters and their families, and would like our new manager to also hold those values. -The position offers a hybrid/flexible schedule, but it is not fully remote.The ideal candidate should be extremely versed in -Utilization Review & Utilization Management, training & developing staff, case management, and Workers' Compensation. The nursing manager will be trusted to review and make independent decisions, and work in a collaborative environment. Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the medical necessity and appropriateness of services on-site or in-house. Discuss and review cases UR nurses, attending physician, other healthcare professionals, and the Administrative Manager.

  • Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care.
  • Create and provide reports for upper management and board members.
  • Monitor review guidelines to ensure nurses operate within standard procedures.
  • Train and develop nursing staff, and provide either guidance or course correction when needed.
  • Use Managed Care techniques to manage the patient's care and cost, based on published guidelines and evidence base results.
  • Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality of care issues, and discharge planning. Document rationale for medical decisions made.
  • Identify at-risk members who would benefit from health management programs through comprehensive health assessments.
  • Monitor and evaluate patient's plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions.
  • Promote member and provider satisfaction.
  • Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.
  • Represent Plan in a responsible and professional manner.
  • Perform other duties as assigned.
  • Will provide telemedicine support.
    QUALIFICATIONSMinimum Education and Experience
    • 15+ years of Nursing Experience
    • 5+ Years of Case Management Experience
    • 5+ Years of Managed Care Experience
    • 3+ years of Utilization Management/Review.
    • 3+ years of Management/Supervisory Experience in a Nursing capacity
    • Unrestricted California Nursing License
    • Associates Degree in Nursing
    • Experience working in managed careRequired Knowledge, Skills and Abilities
      • Understanding of utilization review techniques, all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning
      • A need to for a diverse medical/surgical background to understand treatment options for cardiac, orthopedic, GI, GU, neurology, oncology, development, pediatric, clinical, and many other care plans
      • Understanding of health care delivery system access points and services
      • Correct application of health care management guidelines
      • Ability to navigate the healthcare delivery system
      • Negotiation and presentation skills
      • Good decision-making and problem-solving skills
        Amazing Compensation & Benefits Package (benefits start day 1)
        • $125k - $140k (annually)
        • $10k Signing Bonus
        • Retention Bonus
        • 100% covered benefits for employee AND dependents
        • Retirement contribution matching up to 8.3%
        • 13 holidays, 2 weeks vacation, 12 sick days
        • Mon - Fri flexible schedule (no holidays, weekends or overnight)
        • Eligible for hybrid schedule after 6 months of successful training

Keywords: BOARD OF TRUSTEES L.A. CO. FIRE FIGHTERS LOCAL 101, El Monte , Utilization Management Nursing Manager, Executive , El Monte, California

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