Utilization Management Nurse
HumanaSalary not specified
Full Time
Mid-level (3 to 4 years)
Manager of Utilization Management II at Elevance Health
Washington, District of Columbia, United States
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
- Current active unrestricted RN license in the District of Columbia
Responsibilities
- Manages a team of physical health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in highly complex member populations with varying degrees of medical complexity and acuity
- Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations
- Engages in the development and implementation of integrated medical management programs across different member population types covered by the health plan
- Ensures continued compliance with specific medical management standards
- Engages in the development process for medical and clinical management policy, procedures, and strategies
- Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies
- Hires, trains, coaches, counsels, and evaluates performance of both UM
- Assists and provides back up coverage to Case Management team
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What is the salary range for this position?
The salary range for this position is $115,092 to $172,638.
Is this a remote position, or does it require office work?
This role requires working full-time from the posted locations in Washington, D.C., with travel to the office at 609 H Street NE 4 days each week. Candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted.
What are the minimum qualifications and required skills for this role?
Candidates need a BA/BS in Nursing, 6 years of experience as aligned to license including 3 years of prior management experience, and a current active unrestricted RN license in the District of Columbia.
What benefits does Elevance Health offer?
In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, all subject to eligibility requirements. There is also a $2500 sign-on bonus.
What experience makes a candidate stand out for this role?
Preferred qualifications include a Master's in a related Health/Nursing field, 3 years of management experience with direct reports, Managed Care Utilization Management experience in the District, and prior utilization management leadership experience.
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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