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 and compassionate professional for the role of Utilization Management Manager. The primary responsibilities include managing clinical cases, ensuring compliance with health policies, and coordinating necessary services for patients. This role involves analyzing clinical data and making informed decisions based on evidence-based standards, contributing to the optimization of healthcare services.
Key Responsibilities
- Manage assigned clinical cases and make admission determinations using InterQual or MCG criteria.
- Facilitate care by acting as a liaison and identifying gaps in services.
- Coordinate and authorize necessary medical, psychiatric, and psychosocial services.
- Participate in staff meetings and provide insights for service improvement.
- Maintain accurate and timely documentation of clinical data.
- Review all services for fraud and abuse, and perform telephonic utilization review services.
Qualifications
- Minimum of 1-2 years of experience in Utilization Management and diverse clinical settings.
- Active RN license in DC.
- Proficiency in InterQual or MCG software.
- High level of compassion and excellent interpersonal skills.
- Preferred qualifications include a Bachelor's degree and CCM certification.
Skills
- Strong technical skills, including proficiency in InterQual or MCG software.
- Excellent communication and teamwork capabilities.
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.
*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.
