Utilization Management (UM) Program Manager

$1 - $1,000,000 / year

Description The Utilization Management (UM) Program Manager plays a vital role in driving the strategic planning, execution, and continuous enhancement of UM programs. The position ensures the delivery of clinically appropriate and cost-effective care by optimizing utilization management processes across the organization. Key Responsibilities: Lead and manage UM programs to align with organizational goals for quality, efficiency, and compliance. Collaborate closely with clinical UM, Care Management, Quality, Information Technology (IT), and other key stakeholders, to streamline authorization workflows and improve operational efficiency Develop and implement strategies to reduce avoidable denials and enhance patient throughput Ensure adherence to regulatory and accreditation standards through Effective program oversight and compliance monitoring Coordinate complex, multi work stream initiatives that involve cross functional teams Utilize data analytics to inform decision making, identify opportunities for improvement, and measure program outcomes Standardize UM processes, tools, and documentation to promote consistency and scalability Facilitate communication and change management efforts to support successful program adoption and sustainability Support other clinical departments as needed to advance organizational objectives Salary Range: $70,900-$145,200/annually

Manager - Risk Adjustment

Astrana Health Orange, CA

$102,000 - $115,000 / year

Manager - Risk Adjustment Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Nallammai Vijayakumar Compensation: $102,000 - $115,000 / year Description Astrana Health is seeking Manager - Risk Adjustment to oversee risk adjustment initiatives for the organization, including in-home health assessments, embedded NP, medical chart retrieval, HCC risk adjustment data & documentation integrity, and supporting vendor programs. This manager will also oversee implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart. These programs include but are not limited to training and educational activities, Nurse Practitioner and AWV programs, clinical chart review programs, retrospective reviews, encounter submission, data reconciliation, and electronic data submission including supplemental data submissions Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Oversees daily regional operations of the coding and specialists’ team, retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place. Collaborate closely with providers and regional network leadership teams to implement risk adjustment education, processes, and programs effectively for accurate and compliant capture of members' conditions. Identify and analyze implications of key changes to the regulatory & policy environment on provider organizations in the areas of risk adjustment and compliance. Serves as the vendor(Chart review/AWV /Cozeva etc) and provider liaison to ensure coordination of efforts, effective relationship management, cost effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues. Manage the regional employed NP program and the vendor driven AWV program Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps. Support effective business relationships with external entities, including payers and health plan partners with continuous focus on performance improvement related to population clinical quality and patient experience goals. Requires significant collaboration with internal stakeholders including, but not limited to, primary care section and specialty service lines, IT, business services and finance, contracting, compliance, as well as external entities and vendors will be required Manage regional Provider Incentive and Member Incentive Programs Recover dx codes from institutional encounters through hospitalists/encounters Roll out new regional programs as applicable to improve documentation and accurate coding Ensure the accuracy of risk data in and out of core systems Establish EMR connectivity with Astrana Health and provider group/IPA Ensure compliance with all applicable regulatory and accreditation guidelines such as CMS, NCQA, DMHC etc. Develop policy and procedures as required for departmental improvements. Complete special projects when required. Other duties as assigned Qualifications Bachelor’s Degree Current AAPC or AHIMA certification (CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, or RHIA) 5 years’ experience of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry 5 years’ experience in managerial or supervisory capacity Previous experience in value-based revenue and risk adjustment improvement initiatives Experienced with health plan guidelines/criteria/ICE/CMS/NCQA/DMHC Ability to effectively present information within and outside the organization Advanced ability to manage and work with minimal supervision or absence of detailed instruction. Strong computer skills with proficiency using all Microsoft Office products, and demonstrated ability and willingness to learn new software. Excellent time management, project management, organizational and communication skills. Environmental Job Requirements and Working Conditions This is a remote position. Travel to corporate offices in Orange County, Alhambra, or Monterey Park may be required once a year. The national target pay range for this role is: $102,000 - $115,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Advanced Practice Provider Manager (NP/PA) - Pre-Anesthesia

Stanford Health Care Palo Alto, CA

$106.01 - $140.47 / hour

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care job. A Brief Overview The Manager - Advanced Practice Providers (APP) provides administrative and clinical practice leadership to and manages APPs (Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists) in select areas of Stanford Hospital and Clinics. In collaboration with the Director of Advanced Practice, the APP manager will participate in developing structured APP associated metrics for assessing outcomes of APP care and quality of care metrics; in ensuring that APPs meet various state and federal regulatory agency requirements, and ensure that APPs participate in cost-savings and revenue-generating practices. Locations Stanford Health Care What you will do Manages assigned staff and functions by assigning work, developing work procedures consistent with hospital policy, establishing work schedules and monitoring work performance performed by subordinates in order to meet agreed-upon goals, objectives, and target dates. Performs management functions by interviewing and hiring staff members; providing or arranging for training for subordinates; evaluating performance; and recommending or initiating personnel actions such as promotions, transfers, merit salary increases, or disciplinary action in order to ensure adequate and competent staffing as well as initiating or recommending responses to employee grievances. Participate in or lead efforts to assess outcomes of APP care throughout SHC. Ensure that APPs meet or exceed various local, state, and federal regulatory agency requirements. Ensure that APPs throughout SHC have evidence-based practices that support cost-savings and revenue generating inititatives. Collaborates with the Director of Advanced Practice to create, support, or lead initiatives to improve the work environment of APPs throughout SHC. Support the shared leadership model of shared governance and participate in Magnet activities. May also participate in a clinical practice. Education Qualifications Master's Degree ADVANCED PRACTICE NURSE: MASTER'S DEGREE IN NURSING OR OTHER HEALTHCARE-RELATED FIELD FROM AN ACCREDITED UNIVERSITY Bachelor's Degree PHYSICIAN ASSISTANT: BACHELORS DEGREE IN SCIENCE, PHYSICIAN ASSISTANT STUDIES, OR HEALTHCARE RELATED FIELD FROM AN ACCREDITED UNIVERSITY. Experience Qualifications Five (5) years of experience as a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist) Management experience Preferred Required Knowledge, Skills and Abilities Management principles and practices such as, but not limited to, employee hiring, evaluation, counseling, and termination; budgeting; and employee recognition and rewards. Practice evaluation and process improvement. National professional organizational and regulatory agency initiatives. Standards of care and practice of APP roles. Knowledge and demonstrated clinical competence and in depth knowledge in specialty. Knowledge of the organization and operation of trauma services necessary to ensure the delivery of quality, cost-effective and efficient patient care. Ability to communicate effectively, both orally and in writing. Ability to establish and maintain effective relationships with widely diverse groups, including individuals at all levels both within and outside the organization and gain their cooperation. Ability to plan, organize, prioritize, work independently and meet deadlines. Ability to promote a spirit of inquiry and practice based on evidence by using research based knowledge or research utilization methods to identify and implement innovations in patient care and/or participating in research, clinical investigatory or quality projects. Ability to use educational strategies to influence the development of staff and the provision of quality care for patients and families. Communicate effectively in many venues from individual 1-on-1 sessions to a large audience. Recognize/reward or counsel staff. Have strong written and verbal communication skills. Conduct efficient and supportive process improvement activities. Contribute positively, proactively, and adeptly in institution-wide and Center of Advanced Practice initiatives. Translate and implement national initiatives at SHC. Ability to work full-time. Licenses and Certifications PA - Physician Assistant State Licensure or RN - Registered Nurse - State Licensure And/Or Compact State Licensure and NP - Nurse Practitioner or CNS - Clinical Nurse Specialist or CRNA - Certified Nurse Anesthetist These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. Base Pay Scale: Generally starting at $106.01 - $140.47 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Bereavement Manager

Pathways Home Health and Hospice Sunnyvale, CA

$84,011 - $115,680 / year

For over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care, delivered with empathy, kindness, and respect. TITLE: Bereavement Manager OFFICE LOCATION: Sunnyvale SCHEDULE: Full Time SHIFT: M-F 8:30am - 5pm The posted compensation range of $84,011.00 - $115,680.00 (annual salary) is a reasonable estimate that extends from the lowest to the highest pay Pathways Home Health & Hospice in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. Pathways Home Health & Hospice may ultimately pay more or less than the posted range as permitted by law. POSITION SUMMARY: The Hospice Bereavement Manager working collaboratively with the Director of Hospice is responsible for the development, coordination and implementation of a broad range of grief support and grief education programs and materials. Position includes the training and support of volunteers, trainees and Interns for assigned branch offices. This position also supports community relations for bereavement outreach and education. AREAS OF RESPONSIBILITY: • In collaboration with the branch hospice multidisciplinary team, finalizes the survivor’s bereavement risk assessment, facilitates the development of the survivor bereavement plan of care, and coordinates the implementation and evaluation of this plan. • Assesses community bereavement support needs. Develops, coordinates, facilitates and supervises the facilitation of agency sponsored bereavement support groups both on-site and in the community. • Collaborates with the branch office Volunteer Coordinator and Bereavement Clinical Supervisors for the recruitment of bereavement volunteers, including trainees and Interns. • Collaborates with Bereavement Clinical Supervisors to assist with screening, training, and supporting bereavement volunteers, including trainees and Interns, to provide bereavement services and bereavement program support. Primary supervision role is over Bereavement Phone Call/Visit/IDG Volunteer. • Assists Branch Volunteer Coordinator with the maintenance and collection of appropriate bereavement volunteer documentation. • Participates in agency volunteer training. • In collaboration with the Director of Hospice, Branch Office Managers and Coordinators, develops and conducts grief support training and grief education workshops for the Agency and for the community. Assists in developing materials to promote these programs. • Provides, makes provisions or referrals for grief counseling for individuals and families for our Pathways clients and for the community. • As needed, supports and collaborates with Spiritual Care and Social Services to provide staff grief support programs. Also provide, as needed and requested, individual staff grief support. • Collaborates with Director of Hospice, and other bereavement and agency staff to develop the program for memorial events. • Record necessary bereavement contacts and statistical data regarding utilization of grief support services and attendance at education events. • Performs other duties as assigned consistent with skills and training and the goals and mission of the Agency. QUALIFICATIONS: • MSW, MFT or equivalent degree in psychology or related field. • LCSW Required. • Experience in group facilitation and individual counseling. • Experience working with people facing issues related to terminal illness, death and dying, grief and loss individually or in a group setting. • Experience with program development, training and public speaking. • One year of professional social work experience preferred. • Experience and demonstrated competence and comfort working with families in crisis, the frail elderly, the disabled and/or the terminally ill. • Able to work cooperatively as part of an interdisciplinary team in a multi- cultural environment with all levels of management and staff. • Ability and willingness to work a flexible work schedule including evenings and weekends as needed. • A valid California Driver's license and current automobile insurance. • Proficient computer skills using Microsoft Word, Excel and Windows environment.

Advanced Practice Provider Manager (NP/PA) - Pre-Anesthesia

Stanford Health Care Livermore, CA

$106.01 - $140.47 / hour

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care job. A Brief Overview The Manager - Advanced Practice Providers (APP) provides administrative and clinical practice leadership to and manages APPs (Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists) in select areas of Stanford Hospital and Clinics. In collaboration with the Director of Advanced Practice, the APP manager will participate in developing structured APP associated metrics for assessing outcomes of APP care and quality of care metrics; in ensuring that APPs meet various state and federal regulatory agency requirements, and ensure that APPs participate in cost-savings and revenue-generating practices. Locations Stanford Health Care What you will do Manages assigned staff and functions by assigning work, developing work procedures consistent with hospital policy, establishing work schedules and monitoring work performance performed by subordinates in order to meet agreed-upon goals, objectives, and target dates. Performs management functions by interviewing and hiring staff members; providing or arranging for training for subordinates; evaluating performance; and recommending or initiating personnel actions such as promotions, transfers, merit salary increases, or disciplinary action in order to ensure adequate and competent staffing as well as initiating or recommending responses to employee grievances. Participate in or lead efforts to assess outcomes of APP care throughout SHC. Ensure that APPs meet or exceed various local, state, and federal regulatory agency requirements. Ensure that APPs throughout SHC have evidence-based practices that support cost-savings and revenue generating inititatives. Collaborates with the Director of Advanced Practice to create, support, or lead initiatives to improve the work environment of APPs throughout SHC. Support the shared leadership model of shared governance and participate in Magnet activities. May also participate in a clinical practice. Education Qualifications Master's Degree ADVANCED PRACTICE NURSE: MASTER'S DEGREE IN NURSING OR OTHER HEALTHCARE-RELATED FIELD FROM AN ACCREDITED UNIVERSITY Bachelor's Degree PHYSICIAN ASSISTANT: BACHELORS DEGREE IN SCIENCE, PHYSICIAN ASSISTANT STUDIES, OR HEALTHCARE RELATED FIELD FROM AN ACCREDITED UNIVERSITY. Experience Qualifications Five (5) years of experience as a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist) Management experience Preferred Required Knowledge, Skills and Abilities Management principles and practices such as, but not limited to, employee hiring, evaluation, counseling, and termination; budgeting; and employee recognition and rewards. Practice evaluation and process improvement. National professional organizational and regulatory agency initiatives. Standards of care and practice of APP roles. Knowledge and demonstrated clinical competence and in depth knowledge in specialty. Knowledge of the organization and operation of trauma services necessary to ensure the delivery of quality, cost-effective and efficient patient care. Ability to communicate effectively, both orally and in writing. Ability to establish and maintain effective relationships with widely diverse groups, including individuals at all levels both within and outside the organization and gain their cooperation. Ability to plan, organize, prioritize, work independently and meet deadlines. Ability to promote a spirit of inquiry and practice based on evidence by using research based knowledge or research utilization methods to identify and implement innovations in patient care and/or participating in research, clinical investigatory or quality projects. Ability to use educational strategies to influence the development of staff and the provision of quality care for patients and families. Communicate effectively in many venues from individual 1-on-1 sessions to a large audience. Recognize/reward or counsel staff. Have strong written and verbal communication skills. Conduct efficient and supportive process improvement activities. Contribute positively, proactively, and adeptly in institution-wide and Center of Advanced Practice initiatives. Translate and implement national initiatives at SHC. Ability to work full-time. Licenses and Certifications PA - Physician Assistant State Licensure or RN - Registered Nurse - State Licensure And/Or Compact State Licensure and NP - Nurse Practitioner or CNS - Clinical Nurse Specialist or CRNA - Certified Nurse Anesthetist These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. Base Pay Scale: Generally starting at $106.01 - $140.47 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Rheumatologist - supervisor only, remote CA

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