Manager-Utilization Management - FT - Days - Care Coordination-Patient Support @ MV

El Camino Health

  • Mountain View, CA
  • Permanent
  • Full-time
  • 1 month ago
El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen.Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.FTE 1Scheduled Bi-Weekly Hours 80Work Shift Day: 8 hoursJob DescriptionThe Manager of Utilization Management (UM) is responsible for the operational oversight and leadership of the Utilization Management team, including RN Utilization Review Nurses and support staff. This position ensures that UM functions are carried out in accordance with federal and state regulations, CMS Conditions of Participation, payer guidelines, and organizational policies. The Manager leads efforts to optimize appropriate hospital resource utilization, promote timely progression of care, and maintain regulatory compliance while supporting high-quality patient outcomes.Key Responsibilities
  • Operational Oversight:
Oversee the day-to-day operations of the Utilization Management team. Monitor productivity, quality of reviews, and ensure timely and accurate clinical documentation, concurrent reviews, and authorization processes. * Leadership & Staff Development:Recruit, train, supervise, and evaluate staff performance. Provide ongoing coaching and professional development to maintain clinical excellence and compliance. * Regulatory Compliance & Audit Readiness:Ensure adherence to CMS, Joint Commission, state, and payer-specific utilization review requirements. Prepare and support internal and external audits, reviews, and performance improvement activities. * Collaboration & Communication:Serve as a key liaison between Care Coordination, physicians, nursing, finance, revenue cycle, and payers. Facilitate communication to resolve barriers to patient progression and discharge planning. * Data Analysis & Reporting:Track and analyze utilization trends, denials, and avoidable days. Prepare and present dashboards and reports to leadership to inform performance and improvement initiatives. * Policy & Process Improvement:Develop and update UM policies and workflows. Lead initiatives to enhance efficiency, reduce unnecessary delays in care, and improve overall utilization performance.QualificationsRequired:
  • Bachelor’s degree in Nursing
  • Minimum 5 years of experience in case management, utilization review, or related field in an acute care setting
  • Minimum 2 years of leadership or supervisory experience
  • Strong knowledge of InterQual guidelines, CMS regulations, payer authorization processes, and denial management
  • Strong leadership and team management skills
  • Excellent communication, negotiation, and conflict resolution abilities
  • Analytical thinker with ability to interpret data and drive performance
  • Highly organized, detail-oriented, and capable of managing multiple priorities
  • Collaborative and systems-minded approach to care delivery and utilization management
Preferred:
  • Master’s degree in Nursing, Business, or Healthcare Administration
  • Certification in Case Management (ACM, CCM, or equivalent)
  • Experience with Epic or other EMR platforms
License/Certification/Registration Requirements
  • Registered Nurse (RN) license in the state of CA
Salary Range: $87.01 - $130.52 USD HourlyThe Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.

El Camino Health