Manager, Utilization Management Nurse Management
Company: Blue Shield of California
Location: Elk Grove
Posted on: June 24, 2025
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Job Description:
Your Role The Medical Care Solutions Post Service Clinical
Review team is hiring one RN Manager who will be responsible for
leading the clinical team that reviews post service and provider
appeal cases for Commercial Behavioral Health reviews The RN
Manager will report to the Senior RN Manager. In this role you will
be responsible for inventory management, staffing, transformation
readiness, audit readiness, reporting, special projects,
compliance, training and documentation updates as well s be a
resource for problem solving issues. Our leadership model is about
developing great leaders at all levels and creating opportunities
for our people to grow – personally, professionally, and
financially. We are looking for leaders that are energized by
creative and critical thinking, building and sustaining
high-performing teams, getting results the right way, and fostering
continuous learning. Your Work In this role, you will: Establish
operational objectives for department and/or functional areas and
participate with managers and stakeholders to establish shared
objectives Be responsible for team, functional area quality and
compliance results. Prepare files for regulatory and internal
audits. Participate in regulatory and internal audits when
necessary Adhere to the team’s annual budget and participate in
budget planning under the direction of the team’s Manager and
Director Ensure all work-flow procedures and guidelines are clearly
documented, updated, and communicated timely to the team Interpret
or initiate changes in guidelines/policies/procedures Develop and
implement recommendations for improvement of quality and production
Stay current on regulatory changes and industry requirements
Responsible for reporting and analysis, Post Service workflows,
protocols, policies to ensure efficient and effective care
coordination Collaborate with internal business partners Your
Knowledge and Experience Bachelor of Science in Nursing or advanced
degree preferred. Requires a current CA RN license Requires at
least 7 years of prior relevant experience including 3 years of
management experience gained as a team leader, supervisor, or
project/program manager Has functional expertise within the area of
responsibility Behavioral Health experience preferred Experience
with data analysis, trending, and inventory management preferred
Regulatory audit experience with file preps, presentation, and CAP
resolution preferred Understands basic management approaches such
as work scheduling, prioritizing, coaching, and process execution,
work organization, risk management, and delegation
Keywords: Blue Shield of California, Santa Rosa , Manager, Utilization Management Nurse Management, Accounting, Auditing , Elk Grove, California
