Manager, Inpatient and Post Acute Services

Equal Opportunity Statement

Pacific Source is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. Pacific Source values diversity and is committed to a work environment that appreciates and respects differences.

The Manager of Utilization Management (UM) for Inpatient, Post-Acute and Dual Eligible Special Needs (DSN) oversees and directs UM processes for inpatient admissions, post-acute care services, and DSNP members, ensuring compliance, quality, cost-effectiveness, and coordinated care.

• Oversee daily UM operations for inpatient services, including clinical review, authorization, and concurrent review processes.
• Ensure timely level of care determinations aligned with clinical guidelines and regulatory requirements.
• Collaborate with hospital case managers, providers, and interdisciplinary teams to facilitate safe, cost‑effective discharge plans.
• Monitor and analyze inpatient length of stay metrics, readmissions, KPIs, and turnaround times; identify improvement areas.
• Oversee utilization review for skilled nursing facilities, home health, long‑term acute care, and other post‑acute settings to ensure appropriate care.
• Establish effective transitions of care with post‑acute providers to reduce preventable readmissions and promote optimal outcomes.
• Use evidence‑based protocols to ensure medical necessity for continued stays and manage cost‑effectiveness in the post‑acute phase.
• Provide leadership for Dual‑Eligible Special Needs Plan (DSNP) UM, ensuring integration of Medicare and Medicaid requirements.
• Work closely with care coordination teams to address unique DSNP needs, including social determinants of health.
• Ensure compliance with state and federal regulations and DSNP contractual obligations, including timely authorization and appeals processes.
• Develop, implement, and update UM policies and procedures.
• Manage internal and external audits for UM and DSNP activities.
• Collaborate with the UM Director to develop and implement new programs and support departmental goals.
• Supervise the UM inpatient team and staff focused on post‑acute and DSNP reviews.
• Recruit, train, mentor clinical reviewers, nurses, coordinators, and other UM personnel.
• Conduct performance evaluations, set goals, and foster professional development.
• Pursue continuing education to maintain industry best practices.
• Develop and monitor the annual department budget; track spending vs approved budget and take corrective action.
• Lead process improvement initiatives with Lean methodologies, visual boards, and daily huddles.
• Participate in Manager/Supervisor meetings and strategic committees.
• Develop and track utilization metrics; present dashboards and reports to senior leadership.

• Serve as backup to the Director of Utilization Management as needed.
• Meet department and company performance and attendance expectations.
• Follow Pacific Source privacy policy and HIPAA laws concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

• Minimum of seven (7) years clinical experience and at least 3 years direct health plan experience in case management, utilization management, or disease management.
• Prior supervisory or management experience required.
• Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses.
• Certified Case Manager (CCMC) certification preferred.

• Thorough knowledge of medical procedures, diagnoses, care modalities, procedure codes (ICD‑9 &10, CPT), health insurance, and Oregon mandated benefits.
• Knowledge of managed‑care products and third‑party liability (TPL) required.
• Ability to develop, review, and evaluate utilization and case‑management reports.
• Preference for health insurance and state‑mandated benefits experience in adult education.

• Building Trust
• Building a Successful Team
• Aligning Performance…