Manager, Utilization Management

<p>With more than 8,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust. Interested in joining us?</p>

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of Blue Cross Blue Shield of Michigan for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.

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Competitive Total Compensation Package

Overview: <p><strong>Responsible to plan, organize, direct, control, and lead assigned clinical business unit; specialize in development, planning, and leadership; operate within broad objectives to ensure optimum utilization of capital, manpower, and equipment for the assigned clinical business unit.</strong><strong>&nbsp;</strong></p>
Responsibilities: <p>Manage activities of a department including but not limited to planning, problem solving, staff development and communication. Responsible for the overall direction, coordination, and evaluation of department employees in accordance with the organization's policies and applicable laws. Responsible for/oversees interviewing and hiring new employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees. Responsible for analyzing, planning, organizing, budgeting, identifying equipment needs and other functions that are required to maintain and operate efficiently. Responsible for adhering to the budget approved by the Corporate Financial officer. Ability to review quality assessment standards and data collection tools and make recommendation for enhancement. Execute function/area objectives that support continuous improvement. Responsible for special project and/or problem resolutions. Provide effective and efficient solutions to complex business problems. Continuous quality improvement (CQI), education and training, building and facilitating problem solving teams, individual and team consultations, presentations and reporting. Provide guidance with development of improvement process such as turnaround times, complaint logs, vendor management, reconsideration process. Serves as liaison for quality and accreditation issues to area of the corporation. Other duties as assigned.</p>
Requirements: <p><strong>Qualifications</strong></p> <ul> <li>Registered Nurse with current Michigan license (required)</li> <li>Bachelor of Science in Nursing (BSN) or related field (required)</li> <li>Five (5) years clinical experience, preferably within multiple disciplines</li> <li>Two (2) years leadership experience</li> <li>Effective analytical, verbal, and written communication skills</li> <li>Effective clinical judgment</li> <li>Strong analytical and problem resolution skills</li> <li>Ability to work independently and in a team environment</li> <li>Ability to manage multiple tasks</li> <li>Good working knowledge of relevant PC applications</li> <li>Good project management skills</li> <li>Compliance and regulatory training.</li> <li>Knowledge of effective communication techniques and theories</li> </ul> <p>Departmental Preferences:</p> <ul> <li>Strong CMS knowledge of regulatory requirements</li> </ul>