Director, UM - RN: Care Leadership & Compliance

Imperial Management Administrators Services Inc; California; Sur place; USD 150 000 - 170 000; Plein temps

Résumé du poste

Evolving Solution Services is seeking a Director, UM - RN in Pasadena, CA to lead the UM, Prior Authorization and Inpatient teams. The role ensures compliance with federal, state, health plan and NCQA standards while driving operational excellence in daily activities.

The position requires a California RN with 5+ years of management experience in UM/Managed Care and strong leadership, communication, and problem-solving skills to manage staff and coordinate with clinical and non-clinical partners.

Qualifications

• Bachelor's degree in a health care related field.
• At least 5+ years of management experience in a Medical Group, MSO, Hospital, or Health Plan setting with experience in operational/production management.
• At least 5 years of experience in UM/Managed Care setting.

Responsabilités

• Provide operational leadership to the UM/Prior Authorization and Inpatient Teams.
• Ensure compliance with Federal, State, Health Plan and NCQA standards.
• Assign work schedules, delegate reviews, provide direction on review priorities, and ensure staff meet performance goals.
• Document medical management activities timely with supporting information and criteria used to make determinations.
• Conduct inpatient huddles to review census and discuss discharge planning.
• Prepare and participate in UM audits and annual reviews.

Connaissances

MS Office

Communication

Multitasking

Leadership

English proficiency

Formation

Bachelor's degree in a health care related field

Description du poste

Evolving Solution Services is seeking a Director, UM - RN in Pasadena, CA to lead the UM, Prior Authorization and Inpatient teams. The role ensures compliance with federal, state, health plan and NCQA standards while driving operational excellence in daily activities.

The position requires a California RN with 5+ years of management experience in UM/Managed Care and strong leadership, communication, and problem-solving skills to manage staff and coordinate with clinical and non-clinical partners.