Manager, Utilization Management - San Francisco, CA
21 hours ago
Job description
Job Description Summary
The Manager of Inpatient Care provides operational leadership for the Inpatient Team responsible for inpatient utilization review, care coordination, and discharge planning across acute and short‑term sub‑acute settings. The role directs daily workflows, monitors team performance, ensures timely and effective care transitions, and supports high‑quality, cost‑effective inpatient management. The Manager partners closely with RN clinical leadership and Medical Directors to ensure inpatient processes follow established clinical standards, medical policies, regulatory requirements, and organizational procedures. The role leads operational improvements, supports staff development, and promotes a culture of accountability and excellence.
How will you make an impact & Requirements
Primary duties may include, but are not limited to:
- Ensures team adherence to medical policy, member benefits, and organizational protocols supporting medically appropriate, high‑quality, and cost‑effective care.
- Oversees operational activities related to inpatient admission review, continued stay review, discharge planning workflows, and coordination with facilities and providers.
- Oversees team execution of inpatient service authorization and review processes within established protocols. Clinical supervision and nursing judgment are provided by RN leadership and Medical Directors.
- Supports inpatient care coordination by facilitating communication, ensuring timely information exchange, and assisting with discharge planning logistics. Clinical decisions and escalations remain under the RN Director and Medical Directors.
- Leads workflow optimization to improve length‑of‑stay performance, discharge timeliness, and care coordination outcomes.
- Monitors performance metrics, productivity, and service levels; identifies operational opportunities and implements process improvements.
- Hires, trains, coaches, and administratively evaluates performance of direct reports, including RNs, LVNs, and coordinators. Clinical performance oversight is provided by RN leadership.
- Ensures documentation completeness, regulatory readiness, and consistent adherence to processes, escalating clinical concerns to RN leadership as appropriate.
- Collaborates with the RN Director of Utilization Management on protocols, training, and competency expectations for inpatient staff.
Requirements:
- Requires current active unrestricted RN or LVN license in applicable state(s).
- Minimum of 5 years acute care clinical experience; experience in inpatient care management, discharge planning, or concurrent review preferred.
- Demonstrated strengths in communication, workflow management, problem‑solving, and team leadership.
- Experience in utilization review, care coordination, or managed care strongly preferred.
**This position is bonus eligible based on individual and company performance**
Compensation:
$108,466.00
to
$162,699.00
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