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The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHPs overall Utilization Management Out-Patient Operations departmental clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities (e.g., Prior Authorization, UM Call Center operations.
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This position will also oversee delegate clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities.
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Bachelor's degree in Nursing, Healthcare Administration, or another relevant field A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan An active CA Registered Nurse license Current BCLS (AHA) certificate upon hire and maintain current Analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
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We specialize in: Underground Utilities (Gas, Water, Sewer, Fiber Optic, Electrical), Foundations, Bridges, Highways, Airports, Sitework; Various types of Fencing and Guardrail; Power/Utility: Substations, Power Plants Transmission & Distribution, Sitework; Emergency Management: Reconstruction, 24-Hour Storm Response, Storm Hardening, Shoreline Restoration/Stabilization, Debris Removal; Solar Installation and Construction Management.
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As the Supervisor, UM Regulatory & Compliance, you play a pivotal role in ensuring the success, productivity, and regulatory compliance for Prior Authorization process within Utilization Management Out-Patient Services.
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Previous case management experience and demonstrated experience in utilization management, discharge planning, or transfer coordination. Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management.
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Review and improve the Insider Threat Management program, determining data protection needs and implementing technical security controls. Governance or oversight of a third-party risk management program experience preferred.
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Design and configure SAP CI modules, including CI-FICA (Financial Contract Accounting), CI-BRI (Billing and Invoicing), CI-FICPS (Payment Services), CI-OM (Order Management). Specific knowledge of SAP Subscription Order Management processes within the SAP BRIM solution including master data setup.
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Experience working in the public sector and supporting systems for areas such as Police/Fire Dispatch, Airport Operations, Land Management, Finance, Human Resource Management, Utilities and Public Works.
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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Trainings completed in Program Delivery Manager training, Site Inspector training, Public Assistance Operations I (PA Ops I), Public Assistance Operations II (PA Ops II), Project Worksheet (PW) Development, Cost Estimating Format (CEF), Debris Management/Operations, and/or 406 Hazard Mitigation.
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Under the direction of the Manager, Information Security Operations, the Security Operations Engineer III - IAM (Identity Access Management) is an experienced senior level cybersecurity engineering position primarily responsible for the designing, implementation and maintaining of identity and privilege access management systems and processes.
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Diverse Legal Challenges: In-house litigation roles at Allstate encompass a broad spectrum of legal work beyond traditional litigation, including regulatory compliance, risk assessment, and dispute resolution.
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Proficient in demand planning methodologies, statistical forecasting and inventory management principles. BS/BA degree in supply chain management, logistics or business administration, or a related field.
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The Revenue Management Division works with the City Treasurer and the Deputy City Treasurer, and it is responsible for daily cash management and investment of funds for the City of Rancho Cucamonga and the Rancho Cucamonga Fire Protection District.
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utilization management regulatory jobs in Rancho Cucamonga, CA
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