Manager of Utilization Management

GeBBS Consulting, a leader in Healthcare Technology solutions, is helping a San Jose-based health plan partner to identify a Manager of Utilization Management. This is a direct-hire opportunity, with 2-3 days per week on-site required.

Position Description:

The Manager of Utilization Management (UM) is responsible for the direct oversight of internal and external delegated UM functions including the development and implementation of policies, procedures and program development and related quality monitoring. In addition, the Manager of UM is responsible for supervising the Supervisor of UM to ensure that all administrative UM processes are performed in accordance with all applicable state and federal regulatory requirements, policies and procedures and business requirements.

What You’ll Get to Do:

Develop, implement and manage all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, policies and procedures and general business requirements for all lines of business. Develop and implement continuous analysis and quality monitoring of all policies and procedures to evaluate UM staff performance and ensure regulatory compliance, including the development and implementation of effective, measurable corrective action plans to meet targeted strategic outcomes. Ensure the integration of UM operations into other internal and external teams/departments including Quality, Long Term Services and Support (LTSS) and Behavioral Health (BH). Establish and maintain effective interpersonal relationships with all staff, members and/or their authorized representatives, providers and other program or agency representatives. Ensure UM Committee preparedness. Attend off-site meetings. Be involved in recruiting, interviewing, and hiring. Develop a high performing department culture and staff (this includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives). Effectively assimilate, train and mentor staff and (when appropriate), cross train existing staff and initiate retraining (this includes coaching to help increase skills, knowledge and, if applicable, improve performance). Set goals and plan, assign, and direct work consistent with said goals (this includes responding to employees’ needs, ensuring they have the necessary resources to do their work). Appraise performance, addressing complaints and resolve issues (this includes providing regular and effective feedback to employees and completing timely and objective performance reviews).

You’ll Bring these Qualifications:

Unrestricted professional RN licensure in the state of California. Minimum two years of experience in a supervisory capacity in a managed care setting. Understanding and/or experience with Utilization Management. Must be knowledgeable of DHCS, CMS, DMHC regulations and NCQA regulatory Population Health standards. Knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. Ability to use a keyboard with moderate speed and high level of accuracy. Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to internal departments, members, providers and outside entities over the telephone, in person or in writing. Ability to comply with all internal policies and procedures. Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. Ability to assume responsibility and exercise sound judgment when making decisions within the scope of this position. Maintenance of a valid California Driver's License and acceptable driving record in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events.

About GeBBS:

GeBBS Consulting has established itself as a leading technology and consulting partner for leading Health Plans, Hospitals, and many of the largest healthcare software firms. We are experts at mobilizing highly skilled teams and individual subject matter experts to deliver your projects on time within budget.

Today’s healthcare industry is wildly complex and undergoing constant change. Our team of industry and technology experts will bring order to your mission critical projects and engage the necessary expertise to achieve successful delivery and completion.

Our core expertise includes: Project / Program Management Managed Care / Health Plan Systems ACA / Mandates Hospital: EMR / Clinical / Meaningful Use HIM / Certified Professional Coders

Recruiting Fraud:

Over the past year, online recruitment scams have increased in frequency, impacting both applicants and employers. To help protect yourself against potential scammers, please note the following recruitment practices employed by GeBBS Consulting. GeBBS Consulting uses a single domain name for all recruiting activities and all Authorized GeBBS Consulting Recruiters use the same domain name for all email correspondences. The official GeBBS Consulting domain is gebbsconsulting.com. If you receive emails or are directed to an email other than gebbsconsulting.com, you are not responding to GeBBS Consulting. GeBBS Consulting screens applicants through a combination of over-the-phone, video and in-person meetings. GeBBS Consulting will never ask a candidate for payment of any kind as part of the hiring or onboarding process.

GeBBS Consulting is an Equal Opportunity Employer.