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Manager of Utilization Management

Camarillo, CA

Temp-Hire

$DOE

Essential Functions

  • Must have working knowledge of MS Office environment, and ability to function in highly computerized environment.

  • The Manager makes staff assignments. Evaluates staff and determines the quality of their work efforts.

  • Develops or assists in the development of related prior authorization and claims policy, incorporating current literature and professionally recognized standards.

  • Develops or assists in development and implementation of policy and plans for effective patient centered utilization management and case management.

  • Develops and/or implements effective ongoing programs to measure, assess, and improve quality of processes and workflows, treatment, and services delivered to patients.

  • Develops productive work teams; recommends disciplinary actions; collaborates with clinical leadership for educational programs. compiles data and prepares periodic reports; responsible for coordinating and providing appropriate coverage.

  • Maintains contacts with individuals both within and outside of the department who might impact program activities.

  • Assures optimal quality of care and service is provided.

  • Participates in Quality Assurance Programs as needed; intervenes in crisis situations and investigates all unusual incidents.

  • Leads and participates in meetings; may speak on behalf of department.

  • Management level experience including but not limited to: staff oversight, program management, and issue resolution.

Education

  • Active RN or LVN

Experience

  • Minimum of 5 years’ recent clinical experience.

  • Minimum of 3 years’ experience in IPA or managed care setting preferred.

  • Experience supervising staff and monitoring productivity/performance required.

  • Prior experience with project development and implementation.

  • Must have excellent communications skills both verbally and written.

  • Project Management experiences a plus.

Other Requirements

  • Active and unrestricted Registered Nursing license

Please apply at:

OnDemand Employment Group

2011 Auto Center Drive #116

Oxnard 93036

P:805 485-4606

F:805-485-4607

E: ODEGJOBS@gmail.com

Please bring with you 2(two) forms of valid identification and an updated resume.

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