What are the responsibilities and job description for the Manager, Utilization Management Nurse Management position at Blue Shield of CA?
Your Role
The Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. The Utilization Management Manager will report to the Director of Utilization Management. In this role you will lead and support a team of clinicians to ensure safe, timely, and appropriate care for members. You will apply advanced clinical knowledge and proven management skills to organize work, coach staff, and manage risk. Your leadership helps drive consistent, high-quality utilization management outcomes.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
- Requires maintaining an active, unrestricted RN license in assigned states or the ability to obtain required state (in addition to primary state license) RN license within 90 days of hire
- Requires 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor or project/program manager
- Requires knowledge of regulatory requirements for government lines of business (Medi-Cal and Medicare)
- Bachelor of Science in Nursing or advanced degree preferred
- Demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
- Strong emotional intelligence skills
- Strong communication and computer navigation skills
- Strong teamwork and collaboration skills
- Strong critical thinking skills
- Independent motivation and strong work ethic
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.