Manager, Utilization Management Nurse Management

Your Role

The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review. In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department's operations with efficiency and attention to detail/quality.

Your Knowledge and Experience

• Requires a current CA RN License
• Bachelors of Science in Nursing or advanced degree preferred.
• Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager
• A minimum of 3+ year experience in inpatient or managed care environment preferred
• Excellent communication, interpersonal, and negotiation skills
• Has functional expertise within the area of responsibility.
• Knowledge of NCQA requirements preferred
• Ability to analyze data and create reports to guide decision-making and process improvements