Job Title: Associate Manager - Duals Utilization Management Inpatient/Post Acute

Job Description:
We are seeking an experienced Associate Manager to oversee the Duals Utilization Management for Inpatient/Post Acute settings. This key position will be responsible for ensuring that the utilization of healthcare services for dual-eligible members (Medicare and Medicaid) is managed efficiently and in compliance with regulations. The Associate Manager will lead a team that reviews and manages inpatient and post-acute care services, ensuring that all services meet the highest clinical, financial, and regulatory standards.

Key Responsibilities:

• Manage the daily operations of the Duals Utilization Management team, ensuring the effective review of inpatient and post-acute care services.
• Develop, implement, and evaluate care management strategies for dual-eligible members in accordance with clinical guidelines and regulatory requirements.
• Lead the review process of admissions, continued stay reviews, and discharge planning to ensure medical necessity and appropriate level of care.
• Provide clinical expertise and guidance to the team regarding medical necessity, regulatory requirements, and quality standards.
• Collaborate with physicians, care teams, and insurance companies to facilitate appropriate care management.
• Monitor and track utilization metrics to identify trends, issues, and opportunities for improvement.
• Ensure compliance with federal, state, and payer-specific regulations, maintaining a focus on cost-effective care and optimal patient outcomes.
• Foster a collaborative work environment that encourages teamwork and continuous improvement.
• Provide education and training to team members to improve clinical knowledge and operational efficiencies.
• Prepare reports and analysis for leadership regarding utilization management performance, cost management, and quality improvement initiatives.

Requirements:

• Registered Nurse (RN) with an active and valid state license.
• Minimum of 5 years of experience in Utilization Management or Care Management, with at least 2 years of management or supervisory experience in inpatient and post-acute care settings.
• Strong understanding of Medicare and Medicaid dual eligibility programs and guidelines.
• Knowledge of state and federal regulations related to utilization management in the healthcare industry.
• Experience in managing healthcare teams and improving processes to enhance operational performance.
• Excellent communication, interpersonal, and leadership skills.
• Ability to work collaboratively with multidisciplinary teams, including healthcare providers, administrative staff, and insurers.
• Proficiency in utilizing clinical management software and other healthcare-related tools.

Benefits:

• Competitive salary and performance-based bonuses.
• Health, dental, and vision insurance coverage.
• Paid time off (PTO) and holiday pay.
• 401(k) retirement savings plan with company match.
• Employee assistance programs (EAP) for personal and professional support.
• Continuing education and professional development opportunities.
• Flexible work arrangements to support work-life balance.
• Comprehensive health and wellness programs for you and your family.

Educational Qualifications:

• Bachelor’s Degree in Nursing (BSN) or related healthcare field (required).
• Certification in Utilization Management (such as Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Accreditation Commission (URAC)) is a plus.
• Advanced degrees or certifications in healthcare management, case management, or related areas are highly desirable.

Company Overview:
We are a leading healthcare provider dedicated to ensuring high-quality care for all patients, with a special focus on dual-eligible populations. Our organization prides itself on its patient-centered approach, offering innovative solutions in care coordination and management. We believe in empowering our employees to make a difference in the lives of those we serve and invest in the professional growth of our staff. Our commitment to diversity and inclusion helps us build strong, effective teams that deliver exceptional healthcare services.

Equal Opportunity Employer Statement:
We are proud to be an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. We ensure that all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, disability, age, or veteran status.

How to Apply:
If you are a seasoned healthcare leader with a passion for providing high-quality care to dual-eligible populations and leading teams, we encourage you to apply for the Associate Manager - Duals Utilization Management Inpatient/Post Acute position. Be part of a team that is making a real difference in the healthcare sector!