We're delighted you're considering joining us!
At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team
Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.
Responsible for the development and management of the Medical Management Program related to the Authorization Request Process. Provides leadership with a focus on implementing, monitoring and maximizing systems and processes that result in timely, appropriate access to and utilization of physician specialty services and improved member health outcomes.
Provide oversight of and accountability for the development, implementation, monitoring, and ongoing improvement of the authorization review process, policies, and budget for all Hill Physicians' regions.
Assure necessary support to carry out the clinical review process (including report design) and support evidence-based decision making related to requests for referral to medical specialty services Maximizes resource (staff and technology) efficiency.
Collaborate with Medical Directors, Chief Medical Officer, and other designated physician leaders regarding clinical decision-making support. Ensures that appropriate physician review of referrals requiring clinical review occurs as part of the medical management program.
Prioritize utilization management activities according to the value, risk, and importance to the organization.
Select and build strong functional team supporting various utilization management activities.
Serve as an interface to health plans. Collaborates with the Compliance Department to ensure we provide appropriate access to medically-necessary care and meet all applicable regulatory and accreditation standards.
Support various governance and internal committees responsible for utilization management activities.
Minimum of three to five years of experience required.
Four years managed-care experience, specifically in Utilization Management highly desired. Demonstrated accomplishments in process improvement in a clinical or operations setting within a medical group, health plan or hospital.
Excellent communication skills, both verbal and written.
Excellent organizational skills.
Demonstrated analytical skills.
Demonstrated critical thinking and decision making skills.
Self-motivated with ability to work independently, take charge, and implement change with excellent follow through.
Strong and proven skills in productivity management and process improvement.
Preferred Skills and Experience
Experience/familiarity with Epic Tapestry authorization systems desired
Knowledge of CMS and DMHC regulatory requirements
Unrestricted California Registered Nurse licensure desired
Work location San Ramon, CA or Sacramento, CA
Hill Physicians is an Equal Opportunity Employer
Hill Physicians Medical Group