Manager, Utilization Management Nurse Management

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. #J-18808-Ljbffr Blue Shield of CA