Utilization Management Nurse Manager
- Blue Shield of California
- | Lakewood, CA
$68,644 per year |
OTHER |
July 22nd, 2025
-
Blue Shield of California -
Lakewood, 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 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 re...
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 ...
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...
At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Everywhere. Every day. It's a lofty goal; we know. But we make it happen with the best...
GQR Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Lynwood, California.Job Description RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNStart Date: ASAPDuration: 52 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelGQR Healthcare is representing a well-known health system seeking exper...
Triage Staffing is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Lynwood, California.Job Description RequirementsSpecialty: OR - Operating RoomDiscipline: RNStart Date: ASAPDuration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: TravelTravel Nursing: OR Lynwood, CALocation: Lynwood, CAStart Date: 7/7/202...
Uniti Med is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Lynwood, California.Job Description RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNStart Date: ASAPDuration: 52 weeksShift: nightsEmployment Type: TravelUniti Med is looking for a Travel ICU RN in Lynwood, CA.This assignment lasts 52 weeks and is scheduled...
Core Medical Group is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Lynwood, California.Job Description RequirementsSpecialty: Labor and DeliveryDiscipline: RNStart Date: ASAPDuration: 13 weeks36 hours per weekShift: 12 hoursEmployment Type: TravelClient in CA seeking Registered Nurse: Labor Deliveryfor the following shift(s): DaysWe ...
Adventist Health is seeking a Registered Nurse (RN) Telemetry for a nursing job in Huntington Park, California.Job Description RequirementsSpecialty: TelemetryDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffCentered in the heart of Boyle Heights, Adventist Health White Memorial is one of the area's leading healthcare providers since 1913. We...
High-Volume Searches
- Utilization Management Nurse jobs
- Utilization Management Nurse jobs near Lakewood, CA
- Utilization Management Nurse jobs Lakewood, CA
- Utilization Management Nurse jobs hiring near Lakewood, CA
- Utilization Management Nurse jobs in Lakewood, CA
- Utilization Management Nurse jobs near me
Blue Shield of California Searches
- Blue Shield of California jobs
- Blue Shield of California jobs near Lakewood, CA
- Blue Shield of California jobs hiring near Lakewood, CA
- Blue Shield of California jobs in Lakewood
- 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 Lakewood, CA
- Utilization Management Nurse Manager jobs near Lakewood, CA
- Utilization Management Nurse Manager jobs hiring near me Lakewood, CA
- Utilization Management Nurse Manager jobs in Lakewood
- Utilization Management Nurse Manager jobs near me
Other job titles you may consider:
- Care manager
- Registered nurse
- Assistant manager
- Nursing
- Nurse
- Nursing manager
Searches you may like:
- Part Time Rn Jobs Near Me
- Part Time Healthcare Jobs
- Nearby Healthcare Jobs
- Job Listings Near Me
- Healthcare Jobs Near Me
Explore opportunities in nearby cities:
- Travel Nurse - CVOR Jobs Near Alhambra, CA
- Registered Nurse (RN) Jobs Near Aliso Viejo, CA
- Staff Registered Nurse (RN) Jobs Near Altadena, CA
- Travel Nurse RN - Operating Room Jobs Near Anaheim, CA
- Utilization Management Nurse Manager Jobs Near Arcadia, CA