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Location: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in-person interaction, communication, and immediate support
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Manager of Utilization Management ll is responsible for managing a team of physical health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity.
Responsibilities
Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may include but are not limited to:
Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
Ensures continued compliance with specific medical management standards.
Engages in the development process for medical and clinical management policy, procedures, and strategies.
Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies.
Hires, trains, coaches, counsels, and evaluates performance of both UM
Assists and provides back up coverage to Case Management team
Minimum Requirements
BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
Current active unrestricted RN license in the District of Columbia is required.
Preferred Qualifications
Masters in related Health/Nursing field preferred.
3 years management experience with direct reports.
Managed Care Utilization Management experience, preferably in the District.
Working knowledge of clinical operations areas including regulatory and accreditation, compliance and quality management.
Must have prior utilization management leadership experience
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.