Davita Inc.
Manager, Utilization Management Nurse Management
Davita Inc., Oakland, California, United States, 94616
Your Role
The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review. In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department's operations with efficiency and attention to detail/quality.
Your Knowledge and Experience Requires a current CA RN License Bachelors of Science in Nursing or advanced degree preferred. Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager A minimum of 3+ year experience in inpatient or managed care environment preferred Excellent communication, interpersonal, and negotiation skills Has functional expertise within the area of responsibility. Knowledge of NCQA requirements preferred Ability to analyze data and create reports to guide decision-making and process improvements
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The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review. In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department's operations with efficiency and attention to detail/quality.
Your Knowledge and Experience Requires a current CA RN License Bachelors of Science in Nursing or advanced degree preferred. Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager A minimum of 3+ year experience in inpatient or managed care environment preferred Excellent communication, interpersonal, and negotiation skills Has functional expertise within the area of responsibility. Knowledge of NCQA requirements preferred Ability to analyze data and create reports to guide decision-making and process improvements
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