Manager, Utilization Management

The Manager of Utilization Management (UM) is responsible for the direct oversight of internal and external delegated UM functions including the development and implementation of policies, procedures and program development and related quality monitoring. In addition, the Manager of UM is responsible for supervising the Supervisor of UM to ensure that all administrative UM processes are performed in accordance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements.

• Unrestricted professional RN licensure in the state of California. (R)
• Minimum two years of experience in a supervisory capacity in a managed care setting. (R)
• Understanding and/or experience with Utilization Management. (R)
• Must be knowledgeable of DHCS, CMS, DMHC regulations and NCQA regulatory Population Health standards. (R)
• Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements.
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R)