Manager, Inpatient and Post Acute Services

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $91.6k - $160.3k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 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-time metrics • 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 and integrate Medicare and Medicaid requirements • Coordinate with care teams to address DSNP enrollees’ needs and social determinants of health • Ensure compliance with regulations, contractual obligations, authorization, and appeals processes • Develop and update utilization management policies and procedures • Prepare for and manage internal and external UM and DSNP audits • Support the UM Director with new programs, strategic planning, and department initiatives • Supervise inpatient, post-acute, and DSNP review teams • Recruit, train, mentor, and evaluate clinical reviewers, nurses, coordinators, and other UM personnel • 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 confidentiality and security requirements • Meet performance and attendance expectations 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, including ICD-9 & 10 and CPT codes • Knowledge of health insurance and State of Oregon mandated benefits • Knowledge of managed care products and third-party liability (TPL) required • Ability to develop, review, and evaluate utilization and case management reports • Experience with adult education preferred • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and light lifting/carrying

🏖️ Benefits

• Equal opportunity employment • Continuing education events • Professional development opportunities • Travel opportunities (approximately 10% of the time)