Utilization Management Lead Case Management

Community Health Group; Chula Vista (CA); In loco; USD 90.000 - 130.000; Tempo pieno

Descrizione del lavoro

Community Health Group seeks an experienced Utilization Management Manager to oversee inpatient and outpatient case management, transition of care, and health home programs. You will supervise UM/UR staff, coordinate care across the continuum, and ensure compliance with CMS and SNP regulations while driving quality improvement initiatives.

The role emphasizes staff development, policy implementation, and collaboration with interdisciplinary teams to optimize member outcomes and resource use in a

Competenze

• 3 years of clinical nursing experience.
• 2 years of UM/UR experience.
• 2 years of managed care experience preferred.
• Familiar with CPT and ICD-10-CM coding; M&R criteria.

Mansioni

• Supervise case managers and concurrent review nurses.
• Coordinate care across the continuum for a targeted client population.
• Develop, implement, and evaluate knowledge base for team.
• Ensure compliance with CMS, Medicare Part D, SNP and CHG policies.
• Prepare regulatory reports and attend committee meetings.

Conoscenze

Clinical nursing

UM/UR experience

Managed care knowledge

Communication skills

Analytical

Formazione

BS in Nursing

MSN preferred

Strumenti

Microsoft Office

Descrizione del lavoro

Community Health Group seeks an experienced Utilization Management Manager to oversee inpatient and outpatient case management, transition of care, and health home programs. You will supervise UM/UR staff, coordinate care across the continuum, and ensure compliance with CMS and SNP regulations while driving quality improvement initiatives.

The role emphasizes staff development, policy implementation, and collaboration with interdisciplinary teams to optimize member outcomes and resource use in a