Manager of Utilization Management

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

The Inpatient Case Management Manager oversees a team of nurses and support staff responsible for managing patients' care within the inpatient, SNF, and Home Health settings. The Manager in this role is a clinical professional with a registered nurse (RN) or licensed vocational nurse (LVN) license. Their responsibilities include direct supervision of inpatient, home health, and durable medical equipment (DME) nurses and support staff. This involves overseeing the inpatient leadership team, developing and implementing policies and procedures, analyzing day-to-day reporting, preparing for audits, providing mentorship to staff, and assisting with performance appraisals. The supervisor also acts as a subject matter expert on professional nursing and Inpatient regulations, representing the Inpatient team in various initiatives and client presentations while liaising with other business units to ensure appropriate discharge planning, work closely with the patient, their families, and the healthcare team to ensure a smooth and effective transition, considering the patient's medical needs and support requirements. The Manager leverages their expertise in care management and their knowledge of available resources to navigate challenging placement scenarios. This may involve collaborating with external providers, advocating for patients' needs, and working to find creative solutions to ensure that patients receive the most suitable care environment. The Manager plays a pivotal role in ensuring a seamless continuum of care for patients. They actively collaborate with various stakeholders, including physicians, social workers, insurance providers, and community organizations, to optimize care pathways and support services. By fostering strong relationships and effective communication, they can ensure a seamless continuum of care and access to necessary resources for patients as they move through different care settings.

• Current CA RN/LVN License required.
• Minimum of 7 years of relevant experience required.
• Minimum of 2 years of management experience as a team leader, supervisor, or project/program manager preferred.
• Requires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).
• Requires knowledge of Inpatient Case Management, Utilization Management, or Utilization Review

• A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.