Keck Medicine of USC
Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (E
Keck Medicine of USC, Los Angeles, California, United States, 90079
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Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union)
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Keck Medicine of USC 6 months ago Be among the first 25 applicants Join to apply for the
Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union)
role at
Keck Medicine of USC The Manager of Utilization Review provides administrative and operational support to the Director of Case Management. The Manager of Utilization Review provides direct supervision to the Utilization Review Specialists, Utilization Management Specialists, Authorization Coordinators, and ancillary staff. The Manager provides staff support regarding difficult/complex cases. The Manager is accountable for daily department operations, including establishing utilization review processes that conform to evidence-based review expectations, payer expectations, support collaboration with organization's billing partners, and appeal processes. This position is responsible for daily team operations, including staffing, assignments, and human resources management.
Below, you will find a complete breakdown of everything required of potential candidates, as well as how to apply Good luck.
Essential Duties
Leadership & Supervision: Manage and mentor a team of RN Utilization Review Specialists, LVN Utilization Management Specialists, Authorization Coordinators, and ancillary staff. Provide guidance and support in the development of staff skills and competencies, including but not limited to orienting, training, daily staffing and staff assignments. Conduct performance evaluations and implement development plans for team members. Engage in special projects, research, consultation and teaching in areas of specialty as needed by the hospital. Provide leadership in quality management and improvement activities, by planning, organizing, coordinating, monitoring and evaluating care and activities provided by personnel. Clinical Review Oversight: Supervise the clinical review process to ensure reviews are conducted accurately and in line with evidence-based guidelines. Develop and implement standards and processes for clinical and non-clinical services provided by Utilization Review team members, including provides organizational planning and program development for needed services. Utilizes advanced theoretical knowledge and skills to act as consultant to the staff and to the administrative team. Collaborate with clinical teams within Care Coordination to resolve complex cases and ensure authorizations of appropriate care levels. Formulates and implements policies and procedures related to areas of management, and provides feedback and statistics to hospital administration regarding areas of oversight. Maintains competencies for hospital, age specific and job specific standards of care, follows hospital procedures for accurate and timely processing of charges. Appeals Management: Develop and implements standards and processes for the formulation and submission of appeal requests for denied services, ensuring they are complete, accurate, and submitted in a timely manner. Analyze trends in denied claims and collaborate with internal and external partners to address and rectify identified issues. Regulatory Compliance: Ensure that all processes comply with relevant healthcare regulations, accreditation standards, and organizational policies. Stay updated on industry standards and changes in regulations to maintain compliance. Legal and ethical standards – to be incorporated into all aspect of Utilization Review processes. Process Improvement: Identify and implement process improvements to enhance the efficiency, effectiveness, and outcomes of the Utilization Review team. Develop and maintain departmental policies and procedures. Participate in the development, monitoring and analysis of process and outcome indicators for the improvement of patient care. Reporting and Analytics: Generate and analyze reports related to utilization review activities and appeal outcomes. Use data to drive decision-making and to identify opportunities for improvement. Prepare and present reports reflective of utilization review activities and appeal outcomes to department meetings, UM Committee meetings, and other committee meetings upon request. Performs other duties as assigned.
Required Qualifications
Req Bachelor’s Degree Nursing Req 3-5 years Clinical experience with an additional five years of experience in hospital-based utilization review. Req 2 years Consecutive years’ experience in Utilization Review leadership in a manager or above capacity. Req Strong leadership and team management skills. Req In-depth knowledge of clinical review and appeal processes and healthcare regulations. Req Excellent analytical, problem-solving, and decision-making abilities. Req Ability to work independently with minimal supervision, exercising judgment and initiative. Req Ability to perform a variety of complex and administrative duties and manage conceptual assignments. Req Effective communication and interpersonal skills. Req Demonstrates ability to effectively work with physicians, staff, and patients. Req Committed to excellence in patient care and customer service.
Preferred Qualifications
Pref Certified Case Manager - CCM (CMSA) Nationally recognized certification such as CCM and/or ACM Pref Proficiency in utilizing healthcare management software and data analysis tools.
Required Licenses/Certifications
Req Registered Nurse - RN (CA Board of Registered Nursing) Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The annual base salary range for this position is $110,240.00 - $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionHealth Care Provider IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Keck Medicine of USC by 2x Sign in to set job alerts for “Care Manager” roles. Los Angeles, CA $55,000.00-$65,000.00 13 hours ago Los Angeles Metropolitan Area 1 month ago Patient Experience, Manager - Full Time 8 Hour Days (Exempt) (Non-Union) Los Angeles Metropolitan Area 2 weeks ago Clinic Manager, Administrative - Downtown Clinic - Full Time 8 Hour Days (Exempt) (Non-Union) Los Angeles Metropolitan Area 1 month ago Manager of Care Delivery Operations, HealthcareManager of Care Delivery Operations, Healthcare Compton, CA $110,000.00-$130,000.00 2 weeks ago Facilities Manager - House of Dior, Beverly HillsManager, Patient and Family Resource Center Los Angeles, CA $75,000.00-$80,000.00 3 weeks ago Norwalk, CA $85,000.00-$95,000.00 3 days ago Manager, Care Management, Full-Time, Day ShiftBilingual Patient Education Manager - Southern CaliforniaBehavioral Care Manager (Pacific Time Hours), Full-TimeHospice Oversight Care Manager (RN) California Rosemead, CA $112,500.00-$158,000.00 1 week ago Clinical Supervisor - Life Learning Center Los Angeles Metropolitan Area $10,000.00-$95,304.00 1 year ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union)
role at
Keck Medicine of USC 6 months ago Be among the first 25 applicants Join to apply for the
Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union)
role at
Keck Medicine of USC The Manager of Utilization Review provides administrative and operational support to the Director of Case Management. The Manager of Utilization Review provides direct supervision to the Utilization Review Specialists, Utilization Management Specialists, Authorization Coordinators, and ancillary staff. The Manager provides staff support regarding difficult/complex cases. The Manager is accountable for daily department operations, including establishing utilization review processes that conform to evidence-based review expectations, payer expectations, support collaboration with organization's billing partners, and appeal processes. This position is responsible for daily team operations, including staffing, assignments, and human resources management.
Below, you will find a complete breakdown of everything required of potential candidates, as well as how to apply Good luck.
Essential Duties
Leadership & Supervision: Manage and mentor a team of RN Utilization Review Specialists, LVN Utilization Management Specialists, Authorization Coordinators, and ancillary staff. Provide guidance and support in the development of staff skills and competencies, including but not limited to orienting, training, daily staffing and staff assignments. Conduct performance evaluations and implement development plans for team members. Engage in special projects, research, consultation and teaching in areas of specialty as needed by the hospital. Provide leadership in quality management and improvement activities, by planning, organizing, coordinating, monitoring and evaluating care and activities provided by personnel. Clinical Review Oversight: Supervise the clinical review process to ensure reviews are conducted accurately and in line with evidence-based guidelines. Develop and implement standards and processes for clinical and non-clinical services provided by Utilization Review team members, including provides organizational planning and program development for needed services. Utilizes advanced theoretical knowledge and skills to act as consultant to the staff and to the administrative team. Collaborate with clinical teams within Care Coordination to resolve complex cases and ensure authorizations of appropriate care levels. Formulates and implements policies and procedures related to areas of management, and provides feedback and statistics to hospital administration regarding areas of oversight. Maintains competencies for hospital, age specific and job specific standards of care, follows hospital procedures for accurate and timely processing of charges. Appeals Management: Develop and implements standards and processes for the formulation and submission of appeal requests for denied services, ensuring they are complete, accurate, and submitted in a timely manner. Analyze trends in denied claims and collaborate with internal and external partners to address and rectify identified issues. Regulatory Compliance: Ensure that all processes comply with relevant healthcare regulations, accreditation standards, and organizational policies. Stay updated on industry standards and changes in regulations to maintain compliance. Legal and ethical standards – to be incorporated into all aspect of Utilization Review processes. Process Improvement: Identify and implement process improvements to enhance the efficiency, effectiveness, and outcomes of the Utilization Review team. Develop and maintain departmental policies and procedures. Participate in the development, monitoring and analysis of process and outcome indicators for the improvement of patient care. Reporting and Analytics: Generate and analyze reports related to utilization review activities and appeal outcomes. Use data to drive decision-making and to identify opportunities for improvement. Prepare and present reports reflective of utilization review activities and appeal outcomes to department meetings, UM Committee meetings, and other committee meetings upon request. Performs other duties as assigned.
Required Qualifications
Req Bachelor’s Degree Nursing Req 3-5 years Clinical experience with an additional five years of experience in hospital-based utilization review. Req 2 years Consecutive years’ experience in Utilization Review leadership in a manager or above capacity. Req Strong leadership and team management skills. Req In-depth knowledge of clinical review and appeal processes and healthcare regulations. Req Excellent analytical, problem-solving, and decision-making abilities. Req Ability to work independently with minimal supervision, exercising judgment and initiative. Req Ability to perform a variety of complex and administrative duties and manage conceptual assignments. Req Effective communication and interpersonal skills. Req Demonstrates ability to effectively work with physicians, staff, and patients. Req Committed to excellence in patient care and customer service.
Preferred Qualifications
Pref Certified Case Manager - CCM (CMSA) Nationally recognized certification such as CCM and/or ACM Pref Proficiency in utilizing healthcare management software and data analysis tools.
Required Licenses/Certifications
Req Registered Nurse - RN (CA Board of Registered Nursing) Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The annual base salary range for this position is $110,240.00 - $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionHealth Care Provider IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Keck Medicine of USC by 2x Sign in to set job alerts for “Care Manager” roles. Los Angeles, CA $55,000.00-$65,000.00 13 hours ago Los Angeles Metropolitan Area 1 month ago Patient Experience, Manager - Full Time 8 Hour Days (Exempt) (Non-Union) Los Angeles Metropolitan Area 2 weeks ago Clinic Manager, Administrative - Downtown Clinic - Full Time 8 Hour Days (Exempt) (Non-Union) Los Angeles Metropolitan Area 1 month ago Manager of Care Delivery Operations, HealthcareManager of Care Delivery Operations, Healthcare Compton, CA $110,000.00-$130,000.00 2 weeks ago Facilities Manager - House of Dior, Beverly HillsManager, Patient and Family Resource Center Los Angeles, CA $75,000.00-$80,000.00 3 weeks ago Norwalk, CA $85,000.00-$95,000.00 3 days ago Manager, Care Management, Full-Time, Day ShiftBilingual Patient Education Manager - Southern CaliforniaBehavioral Care Manager (Pacific Time Hours), Full-TimeHospice Oversight Care Manager (RN) California Rosemead, CA $112,500.00-$158,000.00 1 week ago Clinical Supervisor - Life Learning Center Los Angeles Metropolitan Area $10,000.00-$95,304.00 1 year ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr