text: UM Director of Medical Management RN - California - 10000 Sign On Bonus for External Candidates - 921419 at UnitedHealth Group in Ontario, CA 91764 | Black Enterprise
  UM Director of Medical Management RN - California - 10000 Sign On Bonus for External Candidates - 921419
  North American Medical Management, California, Inc (NAMM California)partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
  As a part of our continued growth, we are searching for aDirector of Medical Management (RN)to join our team.In this role, you will be responsible for providing leadership and administrative oversight, program development, implementation, and evaluation of Case Management & UM Programs, chronic care programs, and support of Prime Care Medical Network, Inc. and IPA Medical Management functions.
  Travel required within the following markets:*San Diego, San Bernardino, Riverside, Palm Springs,Ontario (regional office). The business will adhere to following all COVID-19 social distancing policies and will provide appropriate PPE. The regional office is located in Ontario, CA.
  Oversees one or more IPAs formal utilization and network coordination services.Provides operational oversight and recommends corrective action for all shared services
  Manages the UM results of one or more of the IPAs, including referral management; acute, SNF and Rehab admissions for the IPA
  Continually creates and implements strategies to improve IPA and UM Departments performance
  Participates in PrimeCare Medical network, Inc., IPA Utilization Management meetings to enhance communication and continuity of member care services
  Has management responsibility as assigned for the key Medical ManagementPrograms, Coordinated Care Center, DME and Injectable Units
  Participates in determination of departments goals and objectives, setting organizational structure, staffing, and space planning
  Participates in recruitment, retention, and training of NAMM Case Management staff
  Acts as a resource to other departments in regards to Case Management, Disease Management, and Chronic Care Management.
  Collaborates with appropriate VP of Medical Management, MedicalDirectors, UM Managers, and other IPA staff as well as otherdivision peers
  Conduct needs assessment including:development of methods for determining potential patient enrollment, medical literature review, analysis of pre-program utilization and return on investment
  Development of Program to includeestablishment of policies and procedures, enrollment strategies, member and physician materials, and measurements of program outcome
  Evaluate staff educational needs and coordinate training
  Current, active and unrestricted RN license for the state of California or the ability to obtain one within 90-days of hire
  5 or more years of experience with IPAs, Health Plans and Managed Care networks
  5 or more years of experience as a Case Manager within a managed care environment
  5 or more years of Management experience within the healthcare industry
  Thorough knowledge of regulations and requirements related to utilization management (UM)
  Ability to travel locally within an 80+ mile radius
  Bachelors (BSN) or Masters degree (MSN)
  Experience with QA/QI and program development/process improvement
  Job Keywords: RN, nurse, CCM, case management, utilization management, UM, UR, managed care, Hospital, Ontario, Manager, Director, Care Manager, Care Management, NCQA, SNP, Ontario, CA, Albuquerque, NM, Denver, Colorado, Phoenix, AZ, Las Vegas, NV, LGBTQ, Women, BIPOC