Manager, Inpatient and Post Acute Services

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $91.6k - $160.3k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 20%

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PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Oversee daily utilization management operations for inpatient services, including clinical review, authorization, and concurrent review • Ensure timely level-of-care determinations align with clinical guidelines and regulatory requirements • Collaborate with hospital case managers, providers, and interdisciplinary teams on safe, cost-effective discharge plans • Monitor inpatient length of stay, readmissions, KPIs, and turnaround times to identify improvements • Oversee utilization review for skilled nursing facilities, home health, long-term acute care, and other post-acute settings • Establish transitions of care with post-acute providers to reduce preventable readmissions • Apply evidence-based protocols to determine medical necessity and manage post-acute cost-effectiveness • Lead DSNP utilization management while integrating Medicare and Medicaid requirements • Address DSNP enrollees’ unique needs, including social determinants of health • Ensure compliance with state and federal regulations, contractual obligations, authorizations, and appeals • Develop and update utilization management policies and procedures • Prepare for and manage internal and external audits • Support the UM Director with new programs and department initiatives • Directly supervise inpatient, post-acute, and DSNP utilization management staff • Recruit, train, mentor, evaluate, and develop team members • Develop and monitor the annual department budget • Lead process improvement using Lean methodologies, visual boards, and daily huddles • Participate in manager/supervisor meetings and strategic internal and external committees • Develop metrics and present monthly/quarterly dashboards and actionable reports to senior leadership • Serve as backup to the Director of Utilization Management as needed • Follow privacy policy and HIPAA requirements and perform other assigned duties

🎯 Requirements

• Minimum of seven (7) years of clinical experience • Minimum of 3 years of direct health plan experience in case management, utilization management, or disease management • Prior supervisory or management experience • Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses • Certified Case Manager Certification accredited by CCMC preferred • Thorough knowledge of medical procedures, diagnoses, care modalities, procedure codes, ICD-9 and ICD-10, and CPT codes • Knowledge of health insurance and State of Oregon mandated benefits • Knowledge of managed care products and third-party liability (TPL) • Ability to develop, review, and evaluate utilization and case management reports • Adult education experience preferred • Ability to read and comprehend written and spoken English • Clear and effective communication • Ability to stoop and bend • Ability to sit and/or stand for extended periods • Ability to perform repetitive typing, sorting, and filing • Ability to lift and carry files and business materials • Approximately 10% travel required

🏖️ Benefits

• Continuing education events • Professional development opportunities • Equal opportunity employment • Work environment supporting diversity, equity, inclusion, and social justice • Ergonomically configured equipment • At-will employment