Manager Utilization Review/Medical Specialist - Full Time Exempt - Days - 8Hr

Current Emanate Health Employees - Please log into your Workday account to apply

Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.

Job Summary

The Manager Utilization Review/MediCal Specialist will develop and maintain a full Medi-Cal case management program, and oversee services related to the management of the continuum of care from pre-admission through post-discharge for Medi-Cal patients. The Manager Utilization Review/MediCal Specialist will manage the program to provide the appropriate care and hospital services for all Medi-Cal patients while maximizing reimbursement through coordination of services. Key responsibilities also include development and facilitation of educational in-services for medical staff, case managers, utilization management, discharge planning and other professional personnel.

Job Requirements

Minimum Education Requirement:

Associate or diploma degree in Nursing required. Bachelor`s Degree in Nursing or in a related field preferred. Proficient in Outlook, Excel, Word and Access required.

Minimum Experience Requirement:

Two years recent acute clinical experience. Minimum of two recent years of Case Management, Utilization Review or Medi-Cal experience or related programs required.

Experience with medical necessity, utilization management and/or Medi-Cal experience preferred. Excellent verbal, written and organizational skills required.

Expert knowledge of current Medi-Cal rules and regulations with ability to keep abreast of new rules, guidelines and regulations.

Self-motivated and results-oriented. Must be able to demonstrate sound decision making and prioritization skills. Ability to interact professionally with physicians, nurses and other professional personnel, patients, family members and outside agency staff. Excellent customer service required.

Minimum License Requirement:

Current California RN or LVN license. RN license is preferred. Maintains BLS certification.

Delivering world-class health care one patient at a time.

Pay Range:

$42.36 - $62.27