Utilization Management (UM) Manager

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: Astiva Health Inc is looking for a highly energetic and collaborative Utilization Management Manager. This role will report to the UM Director. The primary objective of the UM Manager is to foster an environment of excellence in servicing Astiva Health’s members. This includes extensive interaction with client organizations and multiple stakeholders, delivering a high-quality UM operation meeting and exceeding all service level agreements (SLA) and KPIs, driving operational excellence, and building competencies for delivery.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Performing ad hoc UM functional audits and delegation oversight audits.
• Analyzing data and preparing concise, accurate, and meaningful reports in accordance with UM policies and procedures; defining opportunities for improvement through trend analysis and communicating information appropriately.
• Ensures SLAs are met and reported monthly.
• Lead orientation and training for new Utilization Management staff related to managing role/workflow expectations.
• Perform case reviews of Utilization Management Coordinators evaluating policy/protocol adherence, interdisciplinary team collaboration, and utilization trends of engaged populations.
• Provide feedback related to productivity and caseload management opportunities.
• Adhering to company policies and procedures regarding confidentiality and privacy.
• Providing utilization management services and providing supervision and leadership.
• Responsible for directly managing the UM team or as defined by the UM Director.
• Manage each team member of the Utilization Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise.
• Responsible for promoting the ongoing development of all staff and maintaining a professional environment in which all staff can thrive and develop.
• Includes ongoing collaboration and communication with providers, clinical staff, case managers, and clients utilizing collaborative decision-making when appropriate.
• Be responsible for day-to-day interaction and quarterly JOM with client organizations to help run a high-quality UM operation.
• Regular and consistent attendance
• Other duties as assigned

EDUCATION and/or EXPERIENCE:

• Registered Nurse with Active unrestricted US Registered Nurse license required
• Associates or Bachelors Degree required.
• 3 years direct, clinical nursing experience required.
• 2 years of Utilization Management or Case Management experience required.
• 2 year of supervisory, management or team lead experience required.
• Ability to demonstrate problem-solving, facilitation, and analytical skills.
• Microsoft Excel, PowerPoint, Outlook, Teams experience.
• Experience working both independently and, in a team-oriented, collaborative environment.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Free catered lunches