COMPANY SUMMARY:

With over 35 years of experience, our mission is to provide high-quality, affordable healthcare to those in need. We prioritize community support, offer comprehensive career development programs, and promote internal growth. Committed to quality, we continuously monitor and maintain our processes, products, and services, resulting in our status as a FORTUNE 500 healthcare organization.

JOB SUMMARY:

Managed Care Facility Services (HCS) collaborates with members, providers, and multidisciplinary teams to coordinate integrated care across the continuum, including behavioral health and long-term care, for high-need members. HCS ensures patients progress towards desired outcomes with cost-effective, medically appropriate care.

KNOWLEDGE/SKILLS/ABILITIES:

The Utilization Manager, Healthcare Services, oversees integrated HCS teams, ensuring Managed Care Facility members receive timely, optimal clinical, financial, and quality of life outcomes.

MUST BE IN EASTERN TIME ZONE

• Responsible for clinical teams performing care review/utilization management, case management, transition of care, and health management.
• Facilitates integrated HCS management, ensuring regulatory compliance and implementation of the Clinical Model.
• Manages and evaluates team performance, provides coaching, counseling, and staff development.
• Promotes interdepartmental collaboration and oversees daily healthcare service activities.
• Monitors staff productivity, cost-effective service utilization, and quality audit reviews.
• Maintains professional relationships with providers, customers, and state agencies.

Salary: $70,000-$100,000 (Salary based on experience, licenses, location, and certifications)

JOB QUALIFICATIONS:

• Required Education: RN, or equivalent LVN/LPN with experience, or Bachelor's/Master’s in Nursing, Gerontology, Public Health, Social Work, or related field.
• Required Experience: 5+ years in managed healthcare, including 3+ years in utilization management, case management, care transition, or disease management. Minimum 2 years of healthcare or health plan supervisory/managerial experience.
• Preferred Experience: 3+ years supervisory/management experience in a managed healthcare environment. Medicaid/Medicare Population experience with increasing responsibility. 3+ years of clinical nursing experience.
• Preferred License/Certification: CCM, CPHM, CPHQ, or other relevant healthcare or management certification.

Benefits: Yes

Join our team and be part of our commitment to providing quality healthcare services!