Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier. By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
The Manager, Utilization Management is responsible for leadership and management of case and utilization management staff, including operational decisions, daily clinical decisions, process improvement, staff development, and compliance with Virginia Premier policies and procedures.
Supervises Utilization Management (UM) and other support staff according to Virginia Premier policy and procedures to assure that UR reviews and activities are accurate, consistent, and performed in a timely manner.
Assists with the development of UM staff onboarding and training programs.
Coaches staff and supports healthy team dynamics.
Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor utilization management activities.
Review specialized reports to identify trends and opportunities for improvement to enhance relationships with the provider network and service to members.
Ensure requirements for auditing UM decisions, documentation and quality are being met.
Assists Director of UM with ongoing Quality Improvement Program by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program.
Assists in the ongoing development of programs and medical management projects to enhance/expand the medical management department.
Maintains confidentiality of patient information, and Virginia Premier proprietary operational information.
Maintains current knowledge of Virginia Premier policies and procedures.
Participates in continuing education activities as appropriate.
Participates in community programs (which may occur outside of normal business hours).
This position provides services and demonstrates the knowledge and ability to meet the specific needs of all age groups
SPECIAL KNOWLEDGE AND/OR SKILLS
Knowledge of evidence based criteria, such as Interqual.
Excellent problem solving skills
Patient assessment skills
Knowledge of community resources and vendor options, and experience in making appropriate referrals
Ability to negotiate with providers and vendors
Demonstrates excellent verbal and written communications
Demonstrates working knowledge of computers and word processing programs
Ability to build and support successful work teams
Possess knowledge of ICD-9 and CPT4 coding
Knowledge of Six Sigma Lean methodology or other Performance Improvement methodology
Minimum of 3 years utilization management experience, preferably in a managed care environment
Minimum of 1 year Management experience
Experience in clinical nursing
Experience working with low income disadvantaged populations.
Physical health sufficient to meet the ergonomic standards and demands of the position.
Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Our mission is to inspire healthy living within the communities we serve!
2 openings. Employer will assist with relocation costs.
Internal Number: 2017-4136
About Virginia Premier
Virginia Premier is a managed care organization owned by the Virginia Commonwealth University Medical Center. We inspire healthy living within the communities served by VCU Health System, in Virginia and beyond, through innovation, strategic partnerships, and industry-leading healthcare, with a focus on underserved and vulnerable populations.
We are committed to recruiting, employing and retaining individuals who will live our philosophy of providing the best service to our members, providers, vendors and internal customers.
With locations all across the state of Virginia, we are proud of our track record of developing and promoting our employees. We encourage our employees to take advantage of our multiple ways to continue their education, including our generous Tuition Reimbursement Program. We are committed to the continuous growth and development of our most valuable asset, our employees.