Utilization Management Nurse Manager
- Blue Shield of California
- | Fullerton, CA
$68,644 per year |
OTHER |
July 22nd, 2025
-
Blue Shield of California -
Fullerton, CA
-
$68,644 per year
-
OTHER
-
July 22nd, 2025
Your Role
The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review. In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department's operations with efficiency and attention to detail/quality.
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
- Develop and maintain FCR workflows, protocols, and policies to ensure efficient and effective care coordination
- Ensure workflow procedures and guidelines are clearly documented and communicated
- Interpret or initiate changes in guidelines/policies/procedures
- Monitor and evaluate the performance of the FCR team and implement improvement strategies as needed
- Keeps team focused on specific and measurable performance goals and monitors performance against clear standards.
- Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
- Provide Ensure the delivery of high-quality, patient-centered care through the management of chronic disease, complex case management, and discharge planning
- Other duties as assigned by Sr Manager
Your Knowledge and Experience
- Requires a current CA RN License
- Bachelors of Science in Nursing or advanced degree preferred.
- Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager
- A minimum of 3+ year experience in inpatient or managed care environment preferred
- Excellent communication, interpersonal, and negotiation skills
- Has functional expertise within the area of responsibility.
- Knowledge of NCQA requirements preferred
- Ability to analyze data and create reports to guide decision-making and process improvements
Subscribe for Latest Jobs
Get job updates directly to your inbox.
Share This job
Spread the word through your favorite platforms.
Similar Jobs
Your RoleThe Utilization Management team reviews inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care for our Shared Services department including concurrent review, transplant and NICU/HROB. The Manager, Utilization Management Nurse Management will report to the Director, Utilization Management. In this ro...
We're seeking experienced and dedicated travel healthcare professionals - nurses and allied specialists alike-for exciting assignments nationwide. As a nationwide travel healthcare professionals, you will have the opportunity to work in various healthcare facilities across the country, providing high-quality patient care and support. CVOR nurse jobs focus on the ...
Job Title: Registered Nurse I Department: Orthopedic Surgery Location: RGH Hours Per Week: Full Time/36 hours per week Schedule: Straight Shift- Nights. Every other weekend/holidays. Sign-On Bonus: $15,000 SUMMARY : As a Registered Nurse (RN), you're the engine and the heart of patient care at Rochester Regional Health. You make a positive differenc...
This is a full-time, 12-hour shift position on the night shift, 7p-7:30a. Every other weekend work is required. At this time we are recruting for start dates the last week of April. Salary range is $50p/h to $65p/h DOERegistered Nurse Career Opportunity Encompass Health: Where Nursing Meets Heart, Home, and HealingAre you seeking a nursing career deeply rooted in...
Mentor Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate us all every day. Join us to...
KPG Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Norwalk, California.Job Description RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNStart Date: 08/04/2025Duration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: Travel To work a contract with KPG Healthcare, a nurse must have...
Ardor Health Solutions is seeking a travel nurse RN Med Surg for a travel nursing job in La Palma, California.Job Description RequirementsSpecialty: Med SurgDiscipline: RNStart Date: 07/22/2025Duration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: Travel Location: La Palma, CA Setting: Hospital Employment Type: Traveler Ardor Health Solutions...
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people...
High-Volume Searches
- Utilization Management Nurse jobs
- Utilization Management Nurse jobs near Fullerton, CA
- Utilization Management Nurse jobs Fullerton, CA
- Utilization Management Nurse jobs hiring near Fullerton, CA
- Utilization Management Nurse jobs in Fullerton, CA
- Utilization Management Nurse jobs near me
Blue Shield of California Searches
- Blue Shield of California jobs
- Blue Shield of California jobs near Fullerton, CA
- Blue Shield of California jobs hiring near Fullerton, CA
- Blue Shield of California jobs in Fullerton
- Blue Shield of California jobs near me
- Blue Shield of California careers
- Blue Shield of California vacancies
Geographic Searches
- Blue Shield of California Utilization Management Nurse jobs near Fullerton, CA
- Utilization Management Nurse Manager jobs near Fullerton, CA
- Utilization Management Nurse Manager jobs hiring near me Fullerton, CA
- Utilization Management Nurse Manager jobs in Fullerton
- Utilization Management Nurse Manager jobs near me
Other job titles you may consider:
- Nurse
- Registered nurse
- Nurse manager
- Nursing manager
- Assistant manager
- Nursing
Searches you may like:
- Rn Jobs Near Me
- Part Time Rn Jobs Near Me
- Nursing Jobs Near Me
- Nurse Jobs Near Me
- Hospitals Hiring Near Me
Explore opportunities in nearby cities:
- Nurse Practitioner Jobs Near Alhambra, CA
- Travel Nurse - CVOR Jobs Near Aliso Viejo, CA
- Registered Nurse (RN) Jobs Near Altadena, CA
- Travel Registered Nurse - Med Surg Jobs Near Anaheim, CA
- Utilization Management Nurse Manager Jobs Near Arcadia, CA