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Director of Utilization Management & Quality, Monarch HealthCare - Irvine, CA

UnitedHealth Group

Irvine, CA
Job Code:
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Director of Utilization Management & Quality, Monarch HealthCare - Irvine, CA(Job Number:721839)

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)
As a part of our continued growth, we are searching for a new Director of Utilization Management & Quality to join our team
The Director of Utilization Management & Quality is responsible for the day-to-day management and operations of the Utilization and Case Management Team within the Health Services Department. The Director works in conjunction with the UM/CM Nurse Manager ensuring that care is coordinated while utilizing sound medical judgment within the members benefit plans.
Primary Responsibilities:
  • Clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
  • Adapts departmental plans and priorities to address business and operational challenges
  • Takes lead role in setting direction and participating in or developing new programs
  • Responsible for initiating policies and procedures and health plan audits, Case Management, UM and DM
  • The Director works collaboratively with the members, providers, health plans, and other departments to maximize member’s benefits within a cost effective environment
  • Identify compliance and quality improvement opportunities and initiate corrective actions
  • Assist in implementing procedures to provide excellent customer service to our clients through but not limited to communication, staffing, phone availability and service execution
  • Responsible for trending reports, identifying areas of concern and suggesting alternatives
  • Participate in onsite meetings with Facility Leadership and Providers to discuss current CM trends and how to improve patient outcomes

Job Case Management
Primary Location US-CA-Irvine
Other Location 
Organization Monarch
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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