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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 Work 

​ In this role, you will:​ 

• Establish operational objectives for department or functional area and participate with other managers to establish group objectives 
• Be responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr Manager 
• Develop and maintain FCR workflows, protocols, and policies to ensure efficient and effective care coordination
• Ensure workflow procedures and guidelines are clearly documented and communicated 
• Interpret or initiate changes in guidelines/policies/procedures 
• Monitor and evaluate the performance of the FCR team and implement improvement strategies as needed
• Keeps team focused on specific and measurable performance goals and monitors performance against clear standards.
• Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
• Provide Ensure the delivery of high-quality, patient-centered care through the management of chronic disease, complex case management, and discharge planning
• Other duties as assigned by Sr Manager

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