Senior Manager, Inpatient Utilization Management – LVN/RN Required
Alignment Health
full-time
Posted on:
Location Type: Hybrid
Location: California • United States
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Salary
💰 $98,550 - $147,825 per year
Job Level
About the role
- Manage, train, and mentor a team of UM/Case Managers; enforce performance standards; handle denials and appeals
- Conduct/oversee concurrent review of inpatient stays for medical necessity, appropriateness, and length of stay, using tools like Milliman (MCG) or Medicare manuals
- Act as a liaison between patients, families, providers, and facilities; ensure smooth care transitions and discharge planning
- Ensure documentation meets regulatory and payer requirements; maintain accurate patient records
- Identify opportunities to improve cost-effectiveness while maintaining quality of care
- Prepare reports on quality, utilization, and cost savings for leadership
- Oversee assigned staff; responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees
Requirements
- Minimum 2-3 years recent and related supervisor experience required
- Minimum 5 years related experience in a managed care setting, which includes inpatient and preservice utilization management required
- Minimum 1-2 years recent experience with Medicare Advantage preferred
- Successful completion of an accredited Registered Nursing Program or Vocational Nursing program required
- Bachelor's Degree, Health/Clinical degree (BSN, PA), or business related (Business, Health Administration) preferred
- Knowledge of Medicare Managed Care Plans and CMS regulatory requirements required
- Computer Skills: Word, Excel, Microsoft Outlook
- Experience with the application of clinical criteria (i.e., MCG, InterQual, CMS National and Local Coverage Determinations, etc.) required
- Must have and maintain an active, valid, and unrestricted LVN and/or RN license in California (Non-Compact)
Benefits
- Business travel expenses covered in accordance with company policy
- Equal Opportunity/Affirmative Action Employer
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementinpatient care managementclinical criteria applicationcost-effectiveness analysisreport preparationperformance managementdischarge planningdocumentation compliancepatient record maintenancestaff training
Soft skills
team managementmentoringcommunicationcoachingcounselingleadershiporganizational skillsproblem-solvinginterpersonal skillsperformance appraisal
Certifications
Registered Nursing ProgramVocational Nursing Programactive LVN licenseactive RN license