Mgr Utilization Management Job in Long Beach 90745, California Us
RN Manager of Utilization Management
Molina Healthcare Inc. is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, and Medicare, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Currently we provide healthcare assistance to approximately 1.4 million members in sixteen (16) states. Molina has health plans in California, Indiana, Michigan, New Mexico, Ohio, Texas, Utah, Washington, Florida, Louisiana, Idaho, Maine, New Jersey, West Virginia, Virginia, Wisconsin and as well as 19 primary care clinics located in Northern and Southern California. The company's corporate headquarters are in Long Beach, California.
Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,500 employees and revenues of $3.6 billion.
Molina Healthcare, Inc. has an immediate opening for a Manager of Utilization Management for Long Beach, CA
- Registered Nursing Degree required, Bachelor’s Degree in Nursing preferred, CPUR preferred.
- Minimum 3 years UM Management experience.
- Minimum 5 years clinical nursing experience
- Minimum 2 yrs working experience in Managed Health Care Field.
- Minimum 2 yrs Supervisory/ Managerial experience.
- Knowledge of applicable state, federal and third party regulations and standards.
- Background in discharge planning ;critical care and home health.
- Knowledge of a variety of clinical areas of medical treatment.
- Knowledge of hospital/patient care facilities, current practices, procedures, acceptable medical treatment and diagnoses;
- Skill to learn company policies and procedures as they relate to hospital authorization/denials, physician review, appeals, etc.;
- Skill to successfully apply established guidelines and regulations to specific and individual situations;
- Skill in both oral and written communications to ensure the accurate transferal of information and to build rapport that will ensure the trust, confidence and cooperation of others in a work situation;
- Skill in establishing and maintaining a variety of records necessary to provide complete information and documentation for relevant and appropriate medical determination;
- Problem Solving, Analytical Ability, Communication Skills, and Interpersonal Skills.
- Skill to establish and maintain effective work relationships with those contacted in the performance of required duties.
- Proficiency with PC-based computer systems, ability to learn new information systems and software.
- Excellent organizational skills.
- Valid California State Registered Nursing license (BSN preferred)
- Certified Professional in Utilization Management (CPUR) Certification preferred.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and include the ability to type and operate a personal computer with various software programs, effectively operate standard office equipment, Bend, stoop, crouch, kneel, twist, balance, and work at a desk, Lift and carry up to 25 pounds, and communicate (written and oral) in a clear and professional manner.
Mental/Cognitive Demands: Establish and maintain effective work relationships with co-workers and customers, maintain regular attendance, understand and carry out a variety of oral and written instructions, have knowledge of proper English usage, grammar, punctuation, spelling, and vocabulary, have the ability to learn office principles, practices, and methods, understand filing systems, including numerical, alphabetical, and chronological, learn a variety of procedures, policies, and services of the assigned work unit or program, perform assigned duties with efficiency and accuracy and maintain confidentiality.
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