Manager, Utilization Management in Fairfield, CA at Northbay Healthcare

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Manager, Utilization Management

Full Time, FTE: 1; Salaried/Exempt
NorthBay Medical Center
Fairfield, CA

Job Summary:

The Manager of Utilization Management (UM) is a Registered Nurse with demonstrated UM expertise and at least two years of supervisory experience.  S/he directly manages the UM department and is responsible for appropriate staffing, meeting delegated health plan utilization management (UM) accountabilities and activities that ensure the most efficient use of healthcare services to the patients of NorthBay Healthcare. The Manager of UM works collaboratively with the Director of Case Management, Manager of Social Services, and Operations Coordinator to ensure high quality, cost effective Care Management and UM services are provided to all patients. The Manager of UM has a positive attitude and energy and holds UM staff accountable for quality work while empowering them to perform at their highest level of work function.

The Manager of UM is part of NorthBay’s Management Team and reports to the AVP of Care Management. 

Education: 

1. Bachelors Degree or higher in Nursing required.
2. Masters Degree in Nursing/Health Administration preferred. 

Licensure and Certification:

1. Current California RN License. 
2. Certification in Case Management (ACMA or CCM) required within 6 months of hire. 

Experience, Knowledge and Skills:

1. Minimum of 5 years Utilization Management/Outpatient Case Management experience required.
2. 5 years progressively responsible management/supervisory experience.
3. Demonstrated skills and experience in Utilization Management/ Outpatient Case Management.
4. Extensive utilization management (UM)/capitation knowledge required.
5. Knowledge of NCQA requirements relative to Utilization Management. 
6. Excellent oral and written communication skills required. 
7. Possesses teaching ability, leadership ability, and high professional standards. 
8. Must be well organized, be able to set priorities, work independently and is an effective team member. 
9. Word Processing and Excel skills required.
10. Ability to interact in a professional manner with administration, medical staff, and hospital personnel as well as external customers.

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