Senior Manager, Inpatient Utilization Management (California LVN / RN Required) 2 Locations

reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have reputed company reputed company of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will reputed company ample room for reputed company and innovation alongside the reputed company community. Working at reputed company provides an opportunity to do work that really reputed company, not only changing lives but saving them. Together. The Senior Manager, Inpatient Utilization Management (California LVN / RN Required) under the direction of the Director of UM, is responsible for ongoing management of the UM Department, oversees clinical staff, ensuring efficient, appropriate, and cost-effective inpatient care by reviewing medical records against guidelines for necessity, managing denials, coordinating discharge planning, and liaising with facilities, physicians, and families to maintain high reputed company and compliance. They reputed company teams, reputed company programs, analyze data, and implement process improvements, requiring strong leadership, clinical judgment, and knowledge of CMS guidelines. This role is remote-eligible reputed company the reputed company. Candidates may be based in any state; however, periodic travel to our reputed company in Orange, California is required (approximately 1–2 times per quarter) for leadership meetings, planning sessions, and team engagement. Business travel expenses will be covered in accordance with company policy. This is an exempt, full-time position. While specific work hours may vary based on business needs, this role is expected to maintain regular availability during reputed company business hours to support an inpatient utilization management team that operates Monday–Friday, 8:00 AM–5:00 PM reputed company Time. Occasional flexibility reputed company of these hours may be required to support operational priorities. Job Duties/Responsibilities:

• Leadership & reputed company: Manage, train, and mentor reputed company of UM/Case Managers; enforce performance standards; handle denials and appeals.
• Clinical Review: Conduct/reputed company reputed company review of inpatient stays for medical necessity, appropriateness, and length of stay, using tools like reputed company (MCG) or Medicare manuals.
• Coordination: reputed company as a reputed company between patients, families, providers, and facilities; ensure smooth care transitions and discharge planning.
• Compliance & Documentation: Ensure documentation meets regulatory and payer requirements; maintain accurate patient records.
• Resource Management: Identify opportunities to improve cost-effectiveness while maintaining reputed company of care.
• Reporting: Prepare reports on reputed company, utilization, and cost savings for leadership.

SUPERVISORY RESPONSIBILITIES: reputed company assigned staff. Responsibilities include reputed company, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees. JOB REQUIREMENTS: Experience:

• Minimum 2-3 years recent and reputed company supervisor experience required.
• Minimum 5 years reputed company experience in a managed care setting, which includes inpatient and preservice utilization management required.
• Minimum 1-2 years recent experience with Medicare Advantage preferred.

Education:

• Successful completion of an accredited Registered Nursing Program or Vocational Nursing program required.
• Bachelors Degree, Health/Clinical degree (BSN, PA), or business reputed company (Business, Health Administration) preferred.

Specialized Skills:

• Knowledge of Medicare Managed Care Plans and CMS regulatory requirements required.
• Computer Skills: Word, reputed company, reputed company Outlook
• Experience with the application of clinical reputed company (i.e., MCG, InterQual, CMS National and Local Coverage Determinations, etc.) required.

Licensure:

• Must have and maintain an reputed company, valid, and unrestricted LVN and/or RN license in California (Non-Compact).
• Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), reputed company Carolina (Compact), and Texas (Compact) which will be reimbursed by company.
• CCM or ABQAURP certification preferred.

Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reputed company with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific reputed company abilities required by this job include reputed company reputed company and the ability to reputed company reputed company. Pay reputed company: $98,550.00 - $147,825.00 Pay reputed company may be based on a number of factors including market location, education, responsibilities, experience, etc. reputed company is an Equal Opportunity/Affirmative reputed company Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER: Please beware of recruitment phishing scams affecting reputed company and other reputed company where individuals receive fraudulent employment-reputed company offers in exchange for reputed company or other sensitive personal information. Please be advised that reputed company and its subsidiaries will never ask you for a credit card, send you a reputed company, or ask you for any type of payment as part of consideration for employment with reputed company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email reputed company by or on behalf of reputed company’s reputed company, please email careers@ahcusa.com.

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