What are the responsibilities and job description for the Manager, Utilization Management Nurse Management position at Blue Shield of California?
Your Role
The Medical Care Solutions Appeals and Grievance team is hiring an RN manager who will be responsible for leading the clinical appeals and grievance team for Commercial and MediCare. The RN manager will report to the Sr. RN Manager. In this role you will be responsible for inventory management, staffing, transformation, special projects, and compliance. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Establish operational objectives for department or functional area and participate with other managers to establish group objectives
- Be responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr Manager
- Participate in the development and implementation of the annual budget under the direction of Sr Manager / Director
- Ensure work-flow procedures and guidelines are clearly documented and communicated
- Interpret or initiate changes in guidelines/policies/procedures
- Maintain regulatory compliance
- Develop and implement recommendations for improvement of quality and production
- Stay current on regulatory changes and industry requirements
- Responsible for reporting, analysis, and oversight metrics
- Collaborate with internal business partners
Salary : $77,200 - $97,800