Manager of Utilization Management II at Elevance Health

Washington, District of Columbia, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BA/BS in Nursing field
Minimum of 6 years of experience as aligned to license
3 years prior management experience
Current active unrestricted RN license in the District of Columbia

Responsibilities

Manage a team of physical health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program for highly complex member populations
Provide direct oversight and responsibility for Utilization Management execution/decision making for managed member populations
Engage in the development and implementation of integrated medical management programs across different member population types covered by the health plan
Ensure continued compliance with specific medical management standards
Engage in the development process for medical and clinical management policy, procedures, and strategies
Ensure program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies
Hire, train, coach, counsel, and evaluate performance of UM staff
Assist and provide back up coverage to Case Management team

Skills

Utilization Management

Medical Management

Case Management

Nursing

Regulatory Compliance

Accreditation Standards

Team Management

Performance Evaluation

Policy Development

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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