What are the responsibilities and job description for the Manager, Utilization Management Nurse Management (Prior Authorization) position at Blue Shield of CA?
Your Role
The Utilization Management Prior Authorization team ensures accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Manager, Utilization and Medical Review will report to the Director, Utilization and Medical Review. In this role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiatives. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building, and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
- Requires a bachelor's Degree or equivalent experience
- Requires a current California RN License
- Requires at least 7 years of prior relevant experience including 3 years of management experience
- Has demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
- Requires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, ASO/SA, IFP, Medicare Advantage)
- Requires strong emotional intelligence skills
- Requires the ability to work collaborative with cross functional operations
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
