Manager, Utilization Management Nurse Management

Your Role

The Medical Care Solutions Post Service Clinical Review team is hiring one RN Manager who will be responsible for leading the clinical team that reviews post service and provider appeal cases for Commercial Behavioral Health reviews.. The RN Manager will report to the Senior RN Manager. In this role you will be responsible for inventory management, staffing, transformation readiness, audit readiness, reporting, special projects, compliance, training and documentation updates as well s be a resource for problem solving issues. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor of Science in Nursing or advanced degree preferred.
• Requires a current CA RN license
• 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
• Has functional expertise within the area of responsibility
• Behavioral Health experience preferred
• Experience with data analysis, trending, and inventory management preferred
• Regulatory audit experience with file preps, presentation, and CAP resolution preferred
• Understands basic management approaches such as work scheduling, prioritizing, coaching, and process execution, work organization, risk management, and delegation