Manager, UM Regulatory & Compliance - CCA
Company: Inland Empire Health Plan
Location: Rancho Cucamonga
Posted on: May 7, 2024
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Job Description:
What you can expect!Find joy in serving others with IEHP! We
welcome you to join us in healing and inspiring the human spirit
and to pivot from a job opportunity to an authentic experience!The
Manager, UM Regulatory & Compliance - CCA is responsible for the
coordination, implementation, and oversight of the IEHPs overall
Utilization Management Out-Patient Operations departmental clinical
and operational compliance with regulatory requirements and quality
assurance initiatives related to utilization management out-patient
activities (e.g., Prior Authorization, UM Call Center operations).
This position will also oversee delegate clinical and operational
compliance with regulatory requirements and quality assurance
initiatives related to utilization management out-patient
activities. This role is responsible for the oversight/generation
of all Utilization Management preservice regulatory correspondence
including delivery and content. This role will assist the Director,
UM Operations with the implementation and revision of policies and
standards. This role requires collaboration and communication with
various departments that share Utilization Management functions.
This role will inspire and influence the team towards cultural
transformation of the department through continuous
improvement.PerksIEHP is not only committed to healing and
inspiring the human spirit of our Members, but we also aim to match
our team members with the same energy by providing prime benefits
and more.Competitive salary.Hybrid schedule.CalPERS
retirement.State of the art fitness center on-site.Medical
Insurance with Dental and Vision.Life, short-term, and long-term
disability optionsCareer advancement opportunities and professional
development.Wellness programs that promote a healthy work-life
balance.Flexible Spending Account Health Care/ChildcareCalPERS
retirement457(b) option with a contribution matchPaid life
insurance for employeesPet care insuranceEducation & ExperienceFive
(5) or more years of experience in utilization management in a
health care delivery setting. Three (3) or more years of
supervisory experience with project management and team building
experience essential. Working experience with State and Federal
requirements (DHCS, CMS, DMHC) and quality standards (NCQA).
Supervision can include managing projects and leading the
participants of the project to successful implementation.
Experience with training/mentoring newer Team Members. Organizing a
workgroup to drive the successful implementation of a major program
or process. Experience with Commercial Plan Coverage
required.Bachelors degree in related field from an accredited
institution required.Candidate with an active, unrestricted, and
unencumbered Registered Nurse (RN) issued by the California BRN
without a Bachelors degree will require four (4) years of
additional relevant work experience. This experience is in addition
to the minimum years listed in the Experience Requirements
above.Possession of an active, unrestricted, and unencumbered
Registered Nurse (RN) license issued by the California BRN
required.Yes, must have a valid California Driver's license and
valid automobile insurance. Must qualify and maintain driving
record to drive company vehicles based on IEHP insurance standards
of no more than three (3) points.Understanding and sensitivity to a
multi-cultural environment and community.Key QualificationsState
and federal requirements and regulations of CMS, DHCS, DMHC, and
NCQA.All aspects of managed care operations with extensive
knowledge of HMO and IPA operations with an emphasis on
Utilization/ Case Management and program development. Commercial
managed care coverage.ICD-10 and CPT/HCPC codes.Start your journey
towards a thriving future with IEHP and apply TODAY!by Jobble
Keywords: Inland Empire Health Plan, Altadena , Manager, UM Regulatory & Compliance - CCA, Executive , Rancho Cucamonga, California
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