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Manager - Utilization Management

Position Summary:
The Utilization Management Manager develops, administers and maintains programs and activities specific to utilization management for inpatient and outpatient services for Health Alliance and its partners. Responsible for oversight and resource allocation for utilization management activities in order to coordinate and manage the most effective use of healthcare resources. Promotes ongoing quality of care and services by adhering to the NCQA standards; and responsible for ensuring compliance with all regulatory requirements. Maintains consistency of plan administration across all health plan service areas.


Qualifications:
EDUCATIONAL REQUIREMENTS
College Diploma Nursing

CERTIFICATION & LICENSURE REQUIREMENTS
Registered Nurse (RN) Illinois

EXPERIENCE REQUIREMENTS
Five (5) Healthcare/Medical - Acute Care and Two (2) Managed Care and Nursing and. Management experience in a healthcare or managed care setting.

OTHER REQUIREMENTS
Leadership, organization, and planning skills; the ability to communicate effectively and work collaboratively with medical, administrative, and support staff; the ability to project a positive image of Health Alliance; the ability to make independent decisions, direct, plan and implement new policies and procedures, and accept change; availability for flexible work hours, on?call accessibility and travel to affiliate locations.


Essential Functions:

•Manages operations of department and ensures standards of quality and service are provided in accordance with organizational goals and priorities.
•Assumes responsibility for personnel related duties that include interviewing, disciplinary actions, payroll reporting, scheduling paid leave, and enforcing required rules and regulations. Monitors employee performance and ensures timely communications for the purpose of goal setting, performance evaluations, wages increases and continued personnel actions.
•Participates in the assessment, development, implementation, maintenance and enhancement of computer supported data systems to assure documentation of information promotes a high performing team.
•Responsible to assist in the planning and implementing of the quality and medical management program to ensure compliance with accrediting and regulatory bodies.
•Develops and maintains beneficial working relationships with internal and external customers within the Medical Management scope of responsibility.
•Responsible for identifying and resolving cost-effective, quality care issues in utilization management and case management to achieve competitive advantage in the managed care industry.
•Acts as a resource to the Medical Management Department and to all other Health Alliance departments.

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 4/20/2018 7:29:17 AM