Manager, Inpatient and Post Acute Services

PacificSource Health Plans

Manager of Utilization Management overseeing and directing inpatient admissions and post-acute care services. Ensuring compliance with regulatory requirements and optimizing quality and cost-effectiveness across care continuum.

Posted 7/14/2026full-timeFlorida, North Carolina • 🇺🇸 United StatesSeniorLead💰 $91,587 - $160,278 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in Utilization Management and Case Management, with a strong focus on compliance with clinical guidelines and regulatory requirements. Proven ability to lead teams, develop policies, and implement effective discharge plans to optimize patient outcomes.

Highest-signal resume keywords

Utilization ManagementCase ManagementClinical ReviewLeadership and SupervisionCompliance with Regulations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ExperienceMedical Necessity DeterminationPerformance Metrics AnalysisPolicy DevelopmentICD-9 & 10 CodingCPT CodingManaged Care KnowledgeThird-Party Liability KnowledgeUtilization ReviewDischarge Planning

Soft Skills

CollaborationMentoringCommunicationGoal SettingProfessional Development

Certifications & Qualifications

Registered Nurse LicenseLicensed Clinical Social WorkerCertified Case Manager Certification

Industry Keywords

Dual-Eligible Special Needs PlanInpatient ServicesPost-Acute CareState Mandated BenefitsHealth Insurance

About the role

Key responsibilities & impact

Oversee daily UM operations for inpatient services including clinical review, authorization, and concurrent review processes
Ensure timely level of care determinations alignment with clinical guidelines and regulatory requirements
Collaborate with hospital case managers, providers, and interdisciplinary teams to facilitate safe and cost-effective discharge plans for patients
Monitor and track and analyze inpatient length of stay metrics, readmissions, key performance indicators (KPIs), and turnaround times
Oversee utilization review for skilled nursing facilities, home health, long-term acute care, and other post-acute settings
Establish effective transitions of care with post-acute providers to reduce preventable readmissions and promote optimal member outcomes
Use evidence-based protocols to ensure medical necessity for continued stays
Provide leadership and direction for Dual-Eligible Special Needs Plan (DSNP) utilization management
Ensure compliance with state and federal regulations and DSNP contractual obligations
Develop, implement, and regularly update policies and procedures to ensure compliance and best practices in utilization management
Prepare for and manage internal and external audits pertaining to UM and DSNP activities
Work closely with the UM Director to facilitate the development and implementation of new programs
Directly supervise the UM inpatient team, along with staff focused on post-acute and DSNP reviews
Recruit, train, and mentor clinical reviewers, nurses, coordinators, and other UM personnel
Conduct performance evaluations, set goals, and foster professional development

Requirements

What you’ll need

Minimum of seven (7) years of clinical experience required
Minimum of 3 years direct health plan experience in case management, utilization management, or disease management
Prior supervisory or management experience required
Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses
Certified Case Manager Certification as accredited by CCMC preferred
Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including ICD-9 & 10, CPT codes, health insurance and State of Oregon mandated benefits
Knowledge of managed care products and third-party liability (TPL) is required
Ability to develop, review and evaluate utilization and case management reports
Knowledge of health insurance and State mandated benefits experience in adult education preferred

Benefits

Comp & perks

Flexible telecommute policy
Medical, vision, and dental insurance
Incentive program
Paid time off and holidays
401(k) plan
Volunteer opportunities
Tuition reimbursement and training
Life insurance
Options such as a flexible spending account