You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a dedicated Manager of Utilization Management (RN required). This role involves developing, implementing, and managing all Utilization Management (UM) processes to ensure compliance with applicable state, federal, and accreditation regulations. The role also includes integrating UM operations with other departments and ensuring effective interpersonal relationships.
Responsibilities / Job Duties
- Develop, implement, and manage UM processes for compliance with regulatory requirements.
- Conduct ongoing analysis and quality monitoring of UM policies and procedures.
- Integrate UM operations with internal and external teams like Quality, LTSS, and BH.
- Maintain effective interpersonal relationships with staff and other program representatives.
- Ensure UM Committee preparedness and attend off-site meetings as required.
- Perform supervisory duties including recruitment, team building, training, and performance evaluation.
Minimum Education and Experience Qualification Requirements
Education
Qualifications
- Registered Nurse (RN) license in the State of California.
- At least two years of supervisory experience in a managed care setting.
- Knowledge of Utilization Management and applicable healthcare regulations.
- Proficiency in standard computer software and case management systems.
- Strong written and verbal communication skills.
- Valid California driver’s license or reliable alternative transportation.
Skills
- Technical skills such as proficiency in Outlook, Word, Excel, and case management systems.
- Soft skills including communication, teamwork, and the ability to work under pressure.
Schedule / Shift
8:30am to 5:00pm (30 min lunch break), hybrid schedule - 3 days per week onsite.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
Medix is an equal opportunity employer. We are committed to a socially responsible position by offering an environment that is inclusive and equitable to all.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
