Utilization Management Manager

Phoenix AZ 85034

Job Description

This position is responsible for managing and directing the daily operations of the utilization management department who perform concurrent and retrospective utilization review and facilitating discharge planning. The incumbent has access to Protected Health Information (PHI) as needed to accomplish the accountabilities as outlined in this job description. The Manager is responsible for management, direct supervision and coordination of utilization management staff, including providing expertise in designated programs.
  • Manages staff and monitors performance of assigned work teams, populations and operational efficiencies.
  • Ensures that concurrent and retrospective utilization review is performed using clinical decision making criteria to assure that the appropriate level of care is maintained.
  • Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided; Holds staff accountable for assigned outcomes
  • Ensures coordination of complex discharge planning needs and referrals to appropriate support services.
  • Prepares and evaluates quality and utilization management reports.
  • Participates in clinical rounds and collaborates on post-acute care planning with Care Management colleagues.
  • Works with the Medical Directors for review as appropriate.
  • Provides quality utilization management to reduce health care costs and expenses thereby positively impacting revenues.
  • Manages regulatory requirements to ensure state, local and NCQA standards are met
  • Reports daily productivity and manages staff to ensure they are meeting performance targets
  • Drives performance improvements with staff and department
  • Contributes to Cost of Care in driving to outcomes, reducing cost of care through appropriate utilization, and develops new initiatives based on utilization outcomes

General Job Information

Title

Utilization Management Manager

Grade

26

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/13/2019

Date Requisition Created

3/13/2019

Minimum Qualifications

Education

Associates: Nursing (Required)

License and Certifications - Required

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Minimum of 5 years of post clinical degree experience.

  • Minimum of 2 years of experience in utilization management (admissions, utilization review, and/or discharge planning).

  • Strong knowledge of Medicaid programs.

  • Knowledge of clinical decision making tools.

  • Strong clinical and assessment skills.

  • Outstanding verbal and written communication skills.

  • Ability to work independently and maintain flexibly in fast paced start up environment.

  • Ability to analyze data and use it to improve care delivery.

  • Self-starter with high level of accountability and responsibility for outcome of care.

  • Highly organized and able to manage multiple priorities appropriately.

  • Independent problem solving skills.

  • Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team.

  • Working knowledge of Microsoft Office Product Suite.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”