Your Role

The UM Prior Authorization team conducts medical necessity reviews for services before they are rendered. The Sr. Manager Medical and Utilization Review will report to the Director Medical and Utilization Review. In this role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiates. 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 Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires a current California RN License
• Requires at least 10 years of prior relevant experience including 4 years of management experience
• Requires knowledge of regulatory requirements for all Lines of Business (Medi-Cal, ASO/SA, IFP, Medicare Advantage)
• Requires practical knowledge in leading and managing the execution of processes, projects and tactics within an area
• Requires strong emotional intelligence
• Requires the ability to work collaborative with cross functional operations

Pay Range:

The pay range for this role is: $ 136400.00 to $ 204600.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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