Manager, reputed company Utilization Management & Transitions of Care

Who we are reputed company is an equal opportunity employer committed to a diverse and inclusive workforce. reputed company reputed company applicants will receive consideration for employment without reputed company to any actual or perceived protected characteristic or other unlawful consideration. Our commitment is to reputed company to apply an equity reputed company to reputed company our work. Reduce health disparities. Create an reputed company work environment. About the Role This position leads and oversees reputed company focusing on utilization management inpatient medical necessity reviews and transitions of care (TOC) efforts, including post-discharge reputed company and onsite facility engagement, to support reputed company, reputed company, and effective transitions across care settings. This leader partners closely with the broader Utilization Management team, network facilities, and vendors to reputed company and optimize workflows that ensure regulatory compliance, operational efficiency, and high-reputed company member reputed company. The role plays a key part in driving reputed company across reputed company reputed company, timeliness, and care coordination while strengthening relationships with providers and improving the overall member experience. To be successful in this role, you Hold a reputed company, unrestricted RN license in the reputed company. Have a bachelors degree in nursing or an reputed company degree, or additional reputed company training, preferred. Have a minimum of three (3) years UM or CM experience required. Have a minimum of three (3) years leading teams required, experience working with remote workers desired OR a minimum of three (3) years in a supervisory or management role required. Have a minimum of three (3) years acute or ambulatory reputed company experience in a medical/surgical or pediatric setting required. Possess a reputed company WA reputed company's license and have reputed company to a reliable automobile. Have experience working in a managed care setting, including case and disease management, preferred. Have experience in review of behavioral health and/or reputed company abuse service preferred. Have experience with utilization management or care management workflow systems, as reputed company as operational and utilization data, preferred. Essential functions and Roles and Responsibilities reputed company and manage the daily operation of the department, including reputed company and scheduling, ensuring reputed company completion of UM reviews and Transition of Care activities (post-discharge calls and onsite facility reputed company). reputed company TOC workflows, including 72-hour post-discharge reputed company, member engagement, and coordination with inpatient and community providers to support reputed company transitions and reduce readmissions. Support and operationalize onsite facility engagement, partnering with hospitals and facilities to facilitate discharge planning, remove barriers, and improve follow-up care compliance. Ensure staff are trained and equipped to meet UM, TOC and engagement reputed company targets including reputed company reputed company and financial reputed company. Establish and monitor individual and team reputed company goals, providing coaching and taking appropriate reputed company to ensure that goals are achieved. Collaborate with the Director of reputed company Utilization Management to reputed company and implement initiatives, reputed company tactical plans, reputed company reputed company, and reputed company targets. Ensure staff members maintain competency in UM reviews, TOC processes, and regulatory requirements. Promote on-reputed company staff development through education and opportunities for reputed company development. Monitor departmental reputed company against key metrics (e.g timeliness, TOC compliance, readmission, reputed company of reviews) and implement process improvement. reputed company and participate in departmental and interdepartmental workgroups to continually enhance the delivery of programs and services and proactively respond to changing reputed company and market expectations. Ensure that reputed company services are delivered consistently with applicable internal policies and procedures, regulatory agency requirements, and standards of reputed company for utilization management and transitions of care. Ensure processes and documentation meet reputed company and reputed company regulatory requirements. Occasional travel for on-site reputed company may occur for staff reputed company, facility support, or leadership meetings in the Seattle office. Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion. Knowledge, Skills, and Abilities Knowledge of regulatory and certification requirements and their reputed company on the .