Regional Manager of Utilization Management
Location: United States
Notice
316
Remote?: 1
Highlights (Bonus, shift, relocation, info for job):
Job Summary:
The Regional Manager of UM is responsible for the daily operations of the utilization management/transitional care management team across several markets based on key performance indicators that include reducing potentially preventable events (emergency room visits, hospital admissions, and readmissions, average length of stay), and increasing member post discharge hospital follow up appointments.
Oversight functions include department training/onboarding, performance management, clinical oversight/coaching, and case management to NCQA, regulatory, and health plan standards. This role serves as a utilization management subject matter expert (SME) across the company for both internal and external facing meetings and initiatives. The RMUM partners with counterparts on the medical and behavioral team to deliver integrated care within the collaborative care model. The RGUM represents the mission, vision, and values of AbsoluteCare at all times.
Education & Experience:
- 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 locations within region.
- Licensed Registered Nurse in state of practice 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.
- Familiar with care transitions, strategies for reducing readmissions and chronic condition management interventions a must.
- Experienced in concurrent review for level of care determinations and taking action to transition to other care settings.
- Experience working with high risk and medically complex patients with multiple comorbidities.
- Excellent interpersonal and communications skills.
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.