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Utilization Management Manager - RN - CA - 27030549 in Los Angeles, CA

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Cube Management

Base Salary: At least $80,000
Total Comp: $100,000 to $120,000
Industry: Healthcare
Benifits: Yes
Customers: Small
Car Allowance: No
Sales Cycle: salesCycle
Travel: No Travel
Location: California:, Los Angeles


Aug 23, 2017

Utilization Management Manager - RN - CA - 27030549

Our Client is a growing managed care provider seeking a Utilization Management Manager to implement and authorize all utilization management functions relating to the pre-authorization of select outpatient testing, surgery, and elective inpatient admissions.  All candidates should have experience in utilization management in an outpatient environment.  The Utilization Management Manager - RN will be responsible for daily operations of utilization management staff.

Position Responsibilities:

  • Implement Utilization Programs and policies and procedures to ensure they meet internal, health plan and regulatory requirements.
  • Implement, monitor and ensure referrals meet provider and patient needs, while maintaining and improving utilization metrics.
  • Ensure medical staff competency utilizing reliability tools and evidence based criteria for utilization review.
  • Ensure that patients receive appropriate authorization and access to care, including timely information regarding authorizations.
  • Collaborate with management to identify opportunities for improve utilization management, consistent with vision and strategic long term goals


Education and Qualifications

  • Licensed RN;  but candidates with exceptional experience will be considered with applicable UM experience
  • 5+ years medical utilization - UM
  • 3+ years of management experience in utilization management
  • A depth of experience and strong understanding of managed care referral requirements
  • A strong familiarization with Medicare guidelines and authorization processes
  • Utilization management experience in an outpatient clinical environment.  
  • Knowledge of ambulatory healthcare delivery and management.
  • Working knowledge of NCQA, and health plan requirements related to utilization management.
  • A strong understanding of ambulatory healthcare delivery and management
  • Demonstrated knowledge of prospective authorization process and workflow
  • A track record of accomplishment in handling multiple competing priorities
  • Working knowledge of Microsoft Office Suite, including Windows
  • High energy with demonstrated accomplishment in working independently and in a team environment

Base Salary:  $90,000.00 - $110,000.00 (DOE)

Locations: Irvine, CA

Benefits:  Yes

Relocation: No

Positions: 1

Travel:  5%

If you wish to be part of this successful and vibrant organization, please email a MS Word version of your resume to [please apply online]. This company is an Equal Opportunity / Affirmative Action Employer.

Cube Management is a global recruiting and consulting firm that helps companies accelerate their sales, by providing the top-level talent they need to grow their business. Cube Management is a leading recruiting and consulting partner to emerging growth, mid-market and global companies in the technology, manufacturing, healthcare, consumer package goods and business service sectors. We work across the spectrum of Operations, Sales, Marketing, Safety, Engineering, Accounting and Business Development, providing holistic solutions that drive revenue and profit success. Cube Management combines Strategy, Process and People, to produce great results.

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