Description

Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.

As a Manager for Medicare Advantage Utilization Management, you’ll provide direct management to a team of UM coordinators and nurses. You’ll work closely with Medicare Advantage leadership to plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives. You’ll demonstrate leadership and effective communication by fostering collaborative relationships with peers, co-workers, and staff. You’ll be responsible for overseeing and coordinating the following major functions:

• Pre-service Authorizations/Denial Letters
• Concurrent Review
• Continuity of Care
• Retro Claims
• Retrospective Review
• Referral Automation Business Rules/Configuration