Manager, Utilization Management (Monday - Friday)

Utilization Management Director

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Manage daily operations, including supervision of Health Services Representatives and Clinicians involved in Utilization Management (UM) functions. Integrally involved in the Health Services (HS) program development, implementation, and strategic planning. Accountable for the success of PacificSource UM program development and performance measures, both internal and those established by regulatory entities.

Qualified candidates must be acceptable to the following available work schedule :

• Monday - Friday 8 : 00am to 5 : 00pm

Essential Responsibilities :

Supporting Responsibilities :

Work Experience : 7 years clinical experience required and a minimum of 3 years direct health plan experience in case management, utilization management, or disease management. Prior supervisory or management experience required.

Education, Certificates, Licenses : Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses. Certified Case Manager Certification as accredited by CCMC preferred.

Knowledge : Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including ICD-9 & 10, CPT codes, health insurance and State of Oregon mandated benefits. Knowledge of managed care products and third party liability is required.

Competencies : Building Trust, Building a Successful Team, Aligning Performance for Success, Building Partnerships, Customer Focus, Continuous Improvement, Decision Making, Facilitating Change, Leveraging Diversity, Driving for Results.

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills : Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking.

Our Values :

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.