Elevance Health
Manager of Utilization Management II
Elevance Health, Washington, District of Columbia, us, 20022
Manager of Utilization Management II
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Elevance Health
Location:
This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. Only candidates within a reasonable commuting distance may be considered; accommodations may be provided as required by law.
*This position requires travel to our Washington, D.C. office 4 days each week. The office is located at 609 H. Street NE.
Responsibilities
Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may include but are not limited to:
Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
Ensures continued compliance with specific medical management standards.
Engages in the development process for medical and clinical management policy, procedures, and strategies.
Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies.
Hires, trains, coaches, counsels, and evaluates performance of both UM
Assists and provides back up coverage to Case Management team
BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.
Qualifications
BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.
Preferred Qualifications
Masters in related Health/Nursing field preferred.
3 years management experience with direct reports.
Managed Care Utilization Management experience, preferably in the District.
Working knowledge of clinical operations areas including regulatory and accreditation, compliance and quality management.
Must have prior utilization management leadership experience.
Salary range
for this position is $115,092 to $172,638 for candidates working in person or virtually in the District of Columbia (Washington, DC).
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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–
Elevance Health
Location:
This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. Only candidates within a reasonable commuting distance may be considered; accommodations may be provided as required by law.
*This position requires travel to our Washington, D.C. office 4 days each week. The office is located at 609 H. Street NE.
Responsibilities
Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may include but are not limited to:
Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
Ensures continued compliance with specific medical management standards.
Engages in the development process for medical and clinical management policy, procedures, and strategies.
Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies.
Hires, trains, coaches, counsels, and evaluates performance of both UM
Assists and provides back up coverage to Case Management team
BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.
Qualifications
BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.
Preferred Qualifications
Masters in related Health/Nursing field preferred.
3 years management experience with direct reports.
Managed Care Utilization Management experience, preferably in the District.
Working knowledge of clinical operations areas including regulatory and accreditation, compliance and quality management.
Must have prior utilization management leadership experience.
Salary range
for this position is $115,092 to $172,638 for candidates working in person or virtually in the District of Columbia (Washington, DC).
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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