Nurse Manager - Utilization Management

Nurse Manager - Utilization Management

Locations:

Los Angeles, CA

San Diego, CA

Onsite, Full-Time

Job Summary:

We are seeking an experienced Nurse Manager to lead the day-to-day operations of the Utilization Management Program. This key leadership role is responsible for ensuring quality, cost-effective patient care through effective resource utilization and care coordination. The Nurse Manager will oversee staff in critical areas such as Utilization Review, Discharge Planning, Bed Placement, and Transportation.

Essential Responsibilities:

• Develop and implement policies and procedures related to Utilization Management.
• Collaborate with multidisciplinary teams to coordinate and manage patient care across the continuum.
• Manage members' care in collaboration with hospitals and providers, identifying potential quality of care and risk management issues.
• Oversee transportation programs to ensure efficient and compliant resource utilization.
• Ensure compliance with federal, state, and regulatory agencies including TJC, NCQA, and others.
• Guide staff on utilization review, discharge planning, and care coordination.
• Conduct statistical analysis on utilization trends and outcomes to drive improvements.
• Handle hiring, training, coaching, and performance management of staff.

Qualifications:

• Experience: Minimum of 3 years of case management experience in an acute care setting, including supervisory or management experience.
• Education: BSN or higher required.
• Licenses: Active California Registered Nurse License.
• Certification: Certified Case Manager (CCM) preferred.
• Union Experience: Must have experience managing in a unionized environment.

Compensation & Benefits:

• Salary: $165,000 - $175,000 per year.
• Benefits: Comprehensive package including health, dental, vision, and retirement.

This is an outstanding opportunity for a dedicated Nurse Manager to lead and improve Utilization Management processes in a dynamic healthcare environment.