Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union)...

Join to apply for the Manager, Utilization Review - Care Coordination Admin - Full Time 8 Hour Days (Exempt) (Non-Union) role at USC Rossier Global Executive Ed.D.

Apply Keck Medicine of USC Hospital Los Angeles, California

The Manager of Utilization Review provides administrative and operational support to the Director of Case Management. This role involves supervising Utilization Review Specialists, Utilization Management Specialists, Authorization Coordinators, and ancillary staff. The Manager handles complex cases, oversees daily department operations, and develops utilization review processes aligned with evidence-based standards, payer expectations, and hospital policies. Responsibilities include staffing, human resources management, policy development, and collaboration with clinical teams.

Essential Duties

1. Leadership & Supervision : Manage and mentor a multidisciplinary team, conduct performance evaluations, and support staff development. Engage in quality management activities and special projects.

2. Clinical Review Oversight : Supervise clinical review processes to ensure accuracy and adherence to guidelines.

3. Process Development : Establish standards and procedures for clinical and non-clinical services, and collaborate on case resolutions and policy formulation.

4. Appeals Management : Oversee the preparation and submission of appeal requests, analyze denial trends, and collaborate on issue resolution.

5. Regulatory Compliance : Ensure processes comply with healthcare regulations and standards, staying current on industry updates.

6. Process Improvement : Identify opportunities for efficiency, develop departmental policies, and monitor performance indicators.

7. Reporting and Analytics : Generate reports on utilization review activities, analyze data for improvements, and present findings to relevant committees.

8. Other duties as assigned.

Minimum Qualifications

• Bachelor’s Degree in Nursing
• 3-5 years of clinical experience and five years in hospital-based utilization review
• Two years of leadership experience in utilization review
• Strong leadership, analytical, and communication skills
• Ability to work independently and manage complex duties

Preferred Qualifications

Licenses / Certifications

The annual salary range is $110,240 - $181,896. USC considers various factors when extending offers, including experience, education, skills, and market conditions.

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