Manager of Concurrent Review (UM)
Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
The Manager of Concurrent Review, Utilization Management (UM) leads a team of Concurrent Review nurses that are responsible for supporting Bright’s Concurrent Review function. Manager is responsible clinical staff in the department activity surrounding inpatient review. The department activity may involve intake referral processing, provider coordination and authorization and/or completion of the eligibility, benefits and authorization process. The Manager ensures that services utilized are in compliance with authorization and utilization management guidelines. The Manager will also monitor performance of the team and individual members and takes appropriate action to ensure department goals are met and that staff are utilizing appropriate guidelines to make medical necessity decisions. This individual will serve as a role model for team members, assuring both members and providers have a positive experience with the services they receive. This position is also responsible for ensuring the Concurrent Review team is working to achieve expected clinical outcomes. The Manager of Concurrent Review, Utilization Management ensures all related initiatives meet all applicable state and/or federal regulatory requirements in addition to corresponding URAC standards.
- Provide leadership and direction to a team of Concurrent Review Nurses, inclusive of performance oversight, monitoring the quality of work the team does and ensuring the team is working to achieve expected clinical outcomes.
- Support staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
- Monitor operational key performance indicators to track service delivery against targets.
- Recruit, hire and train new team members.
- Enforce UM policies and procedures to ensure compliance with state and federal agencies as well as accreditation standards.
- Support the development and maintenance of standard operating procedures related to corresponding program functions.
- Participate in the development of operating models to execute utilization management solutions.
- Other duties and responsibilities as assigned.
This position has Supervisory responsibilities for members of the Utilization Management team.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- A minimum of an associate degree in Nursing required.
- Three (3) or more years of Supervisor experience within a consumer support function
- Two (2) or more years of healthcare related experience
- Awareness and experience with HIPAA requirements for healthcare communication
- Prior experience with URAC accreditation is desired, but not required
- Formal training in Six Sigma management techniques is desired, but not required
- Approaches challenges calmly and objectively to identify the best solution
- Capable communicator that can interact with others at multiple levels within the organization, customers and providers
- Leads through influence and example
- Strong operational mindset and uses data to draw insights
- Thrives on driving results in a collaborative environment
LICENSURES AND CERTIFICATIONS
- An active, Registered Nurse (RN) or Licensed Practical Nurse (LPN) license to practice as a health professional in a state or territory of the United States is required for this role.
The majority of work responsibilities are performed in a call center environment, carrying out responsibilities sitting/standing at a desk/table and working on the computer. Travel is not required.
For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $92,964 - $139,446 Annually.
Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
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