Job Information
Express Employment Professionals RN Utilization Manager in Honolulu, Hawaii
Express Healthcare is seeking compassionate to support Utilization Manager, a community-led, non-profit organization. For more information call, 808-792-7000.
Job Title: Utilization Manager
Location: Honolulu,HI
Employment Type: Full-Time
Salary: $100,000 - $110,000
This position is responsible for overseeing day-to-day operations while managing the Utilization Management (UM) program within the Quality Improvement (QI) framework. Core duties include optimizing processes to ensure effective, timely, and cost-efficient care management across medical, behavioral, and community health services. The role involves continuous service monitoring for continuity, necessity, and cost-effectiveness, along with process recommendations to the Director of Medical Management and the Chief Medical Officer.
Key Responsibilities:
- Care Coordination: Work with clinical department managers to oversee members care levels, ensuring services are aligned with patient needs. Monitor continuity and assess timeliness, cost-effectiveness, and medical necessity.
- Outlier and Disability Monitoring: Collaborate to identify high-cost or outlier cases, coordinating actions to minimize organizational risk and liability.
- Data Evaluation and Reporting: Assess data to identify utilization trends, pinpointing overuse or underuse of services. Evaluate member demographics to uncover patterns and design community interventions to improve health outcomes.
- Committee Support and Recommendations: Support the Senior Medical Director by preparing materials for UM Workgroup/Committee meetings. Relay UM Workgroup recommendations to the Provider Advisory Committee for review and approval.
- Individualized Care Planning: Partner with clinical managers and inpatient coordinators to create personalized, integrated care plans as needed for individual members.
- Performance Improvement and QI Initiatives: Gather UM data for use in performance evaluations and QI initiatives to meet program standards.
Utilization Management Requirements:
- 3-5 years or experience of Utilization Management
- State of Hawaii RN License
- Current BLS Certificate
- Familiar with Medicaid and Medicare regulations
Apply Today:
To learn more or for immediate submission, please reply to this ad with an updated resume, or contact us directly at 808-792-7000. #HIHEALTH
Thank you for choosing Express Healthcare Professionals as your preferred medical staffing and healthcare employment agency in Hawaii! Since 2015, our Express team has provided our community with quality staffing solutions and healthcare jobs in Honolulu, Aiea, Pearl City, Kaneohe, Kailua, Hawaii Kai, Waipahu, Waipio, Kapolei, Waianae, and the whole island of Oahu. and all over the Hawaiian islands. We pride ourselves on being able to make fast, but precise pairings between our area's top medical facilities and licensed clinicians.
Express Healthcare is one of Hawaii's leading per diem staffing companies for RN careers, CNA II's, and LPN's. We bring Hawaii's treatment centers, hospitals, and other medical facilities the best contract, per diem, and direct hire staffing solutions in Honolulu and all of Hawaii!
