Manager of Utilization Management
Location: Philadelphia, PA, USA
Highlights (Bonus, shift, relocation, info for job):
The Manager of Utilization Management is responsible for oversight of daily operations of the utilization management and transitional care management team including ensuring compliance with internal and NCQA timeliness and care plan/documentation standards, case file/performance reviews (e.g., case file audits, ride along, 1:1 coaching), participation in interdisciplinary care team meetings and rounds. The manager of utilization management leads team meetings and maintains team morale through virtual and in-person activities. The manager UM is responsible for interviewing, hiring, and ensuring onboarding/training needs are met for new hires. Success is measured based on key performance indicators that include reducing potentially preventable events (e.g., ER visits, hospital admissions, readmissions, increasing member engagement with TCM and member post discharge hospital follow up visits.
Education & Experience:
- Bachelors degree
- Must be willing and able to travel up to 80% of the time to local area hospitals, skilled nursing facilities, acute rehabilitation facilities and office/center location to build relationships across interdisciplinary care team.
- Registered Nurse with 5 or more years related to utilization management and case management experience.
- 3 years of supervisory experience preferred
- Multiple settings experience (acute inpatient, SNF and home health) preferred.
Why Work at AbsoluteCare?
At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.
We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.
We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.
Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.
AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.
EEO Employer Verbiage: AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.