1857 Senior Management jobs in Hercules

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 

Your Role

The 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 role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiatives. 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 department Director 
• 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 
• Establish and manage operational and regulatory reports
• Ensure regulatory and accreditation standards are met for all lines of business including Commercial, Medicare, and Medi-Cal
• Collaborate across functional departments to improve member outcomes
• Participate in regulatory and internal audits as applicable
• Support and facilitate staff meetings, clinical rounds and weekly huddles

Your Knowledge and Experience

• Requires a bachelor's Degree or equivalent experience 
• Requires a current California RN License 
• Requires at least 7 years of prior relevant experience including 3 years of management experience
• Has demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
• Requires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, Medicare, and Commercial)
• Requires strong emotional intelligence skills
• Requires the ability to work collaborative with cross functional operations
• Requires at least 2 years of prior relevant experience in transplant utilization management review

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 

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 

Your Role

The 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 role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiatives. 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 department Director 
• 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 
• Establish and manage operational and regulatory reports
• Ensure regulatory and accreditation standards are met for all lines of business including Commercial, Medicare, and Medi-Cal
• Collaborate across functional departments to improve member outcomes
• Participate in regulatory and internal audits as applicable
• Support and facilitate staff meetings, clinical rounds and weekly huddles

Your Knowledge and Experience

• Requires a bachelor's Degree or equivalent experience 
• Requires a current California RN License 
• Requires at least 7 years of prior relevant experience including 3 years of management experience
• Has demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
• Requires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, Medicare, and Commercial)
• Requires strong emotional intelligence skills
• Requires the ability to work collaborative with cross functional operations
• Requires at least 2 years of prior relevant experience in transplant utilization management review