RN Manager of Utilization Management

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People. Passion. Purpose

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.  

We are looking for a RN Manager of Utilization Management.  If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, Nevada, then you should consider joining our team.

Overall Purpose:

The Registered Nurse responsible for development and oversight of utilization management functions, staffing, and daily operations for multiple delegated managed care health plan contracts.  

Education and Experience:

  • Bachelor's degree in Nursing in required. Master's degree in preferred.

  • Minimum three years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization, preferred.

  • Minimum two years managerial experience over a managed care, medical management system preferred.

  • Ability to obtain and current registration to practice as a Registered Professional Nurse in the states where P3 has contracts.

  • Experience in utilization management program set up, policy and procedure development for efficient programs, understanding of nationally recognized standards and guidelines (CMS and NCQA). 

  • Experience with standard operating procedure writing.

  • Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required.

Essential Functions:

  • Knowledge of CMS Pre-Service reporting (ODAG and Part C).

  • Attention to detail with strong data validation skills.

  • Ability to understand and create reports and monitor key performance metrics.

  • Collaborates with senior leadership in the development of department strategic goals and objectives to align with overall organizational goals and financial targets. Ensures program integration and implementation of Quality Improvement (QI) activities to ensure services provided meet the needs of the member.

  • Works strategically to advance P3 Health Partners in the community and among health plan clients.  Monitors metrics and staff performance to constantly meet or exceed all organizational targets.  

  • Ensures compliance with all Federal & State Regulations and Requirements and Corporate Policies related to: care management; utilization management; prospective / concurrent / retrospective care processes.

  • Experience with State and external accreditation, managed care audits and reviews required.

  • Ability to work independently under limited direction.

  • Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required.

  • Ability to learn internal and third-party software systems.

     

Location: Las Vegas, NV
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