Clinical Manager, Utilization Management, Full-Time, Days (**For internal candidate only)

Reports to the UM Clinical Director. The UM Manager is responsible for assisting with the overall operations and direction of the Utilization Management department. The UM Manager is responsible for incorporating best practices and ensures effective utilization reviews that will guarantee appropriate reimbursement for hospital services and manages and ensures the productivity of the department in completing initial reviews and concurrent reviews to ensure that the patient is getting the right care in a timely, safe, efficient, and cost-effective way. Additionally, the UM manager must monitor retrospective reviews after treatment has been completed or after discharge to ensure appropriate reimbursement. Works collaboratively with Care Management leadership in providing feedback about any opportunities, trends, and gaps regarding avoidable days or delays or develops a plan when a patient is no longer meeting the acute level of care. Additionally, the UM Manager works closely with physicians and other providers including the Physician Advisor to develop improved utilization of effective and appropriate services.  The UM Manager will provide after-hour support for the Access Department and serve as a point of contact for conflict resolution and provide administrative support for both UM Department and Access Department.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 35 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.