Your Role
The UM Concurrent Review team is responsible for inpatient concurrent review for acute inpatient and lower level of care admissions. The concurrent review nurses actively collaborate with a facilities discharge planners and case managers to ensure our members are receiving the right care at the right time in the right setting. The Manager of UM and Medical Review will report to the Senior Manager of UM and Medical Review. In this role you will be establish medical necessity for inpatient admissions to ensure cost effective timely care. 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 or functional area and participate with other managers to establish group objectives
- Be responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr Manager
- Participate in the development and implementation of the annual budget under the direction of Sr Manager / Director
- Ensure workflow procedures and guidelines are clearly documented and communicated
- Interpret or initiate changes in guidelines/policies/procedures
- Represent UM Concurrent review in cross functional workgroups
- Review inpatient data and implements cost – effective changes
- Uphold the Blue Shield of California mission and values
- Support company and operational goals
- Supports and mentors team members professional development goal
At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in , Join us!