Sign In
 [New User? Sign Up]
Mobile Version

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

UnitedHealth Group


Location:
Irvine, CA
Date:
12/12/2017
2017-12-122018-01-10
Job Code:
738929
Apply on the Company Site
  •  
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

738929 Director of Utilization Management Quality Monarch HealthCare Irvine CA

Director of Utilization Management & Quality, RN - Monarch HealthCare - Irvine, CA (738929)

Position Description

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 our 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
Required Qualifications:
  • Current and unrestricted RN license in the State of California
  • 3+ years of Case Management/UM experience
  • 3+ years of Director / Management experience
  • Advanced computer proficiency in MS Office: Outlook, Word, Excel, PowerPoint
  • Excellent written and verbal communication skills 
Preferred Qualifications:
  • Managed Care work experience
  • Experience in compliance / audits, CMS regulations, NCQA
  • Certified Case Manager (CCM)
  • Bachelor’s Degree in Nursing
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)



Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

Keywords: RN, Director, Manager, Managed care, Utilization Management, UM, Case Management, CM, Quality, Compliance, Irvine, CA

Job Details

  • Contest Number738929
  • Job TitleDirector of Utilization Management & Quality, RN - Monarch HealthCare - Irvine, CA
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

  • Irvine, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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.

Powered ByLogo

Featured Jobs[ View All ]

Featured Employers [ View All ]