Department Manager of Managed Care & Utilization Management

The Manager works closely with the Medical Director to develop efficient systems and methods for delivery of high-quality clinical care to UC Davis Medical Group patients. The incumbent's work is performed with full independence, based on prior agreements and arrangements, and subject to administrative review and approval. The incumbent will provide direction concerning the overall goals and objectives of the department in all aspects, including clinical quality, financial and operational.

Department Overview

The Managed Care and Utilization Management unit is responsible for the administrative services necessary to ensure the provision of health care services to the individuals enrolled with the UC Davis Medical Group or seeking services at the UC Davis Medical Center through Value-Based contract arrangements, including but not limited to capitated or bundled arrangements. Managed Care Utilization Management (UM) interacts daily with the Claims Processing, Member Services and Provider Relations units, as well as UC Davis Health System Contracts Office, Ambulatory Care Administration, Patient Care Services, Office of the Population Health, and all primary and specialty care clinics within the health system.

Apply By 05/10/2025 at 11:59pm; Review of applications will begin 04/21/2025 and interview process may occur at any time

Minimum Qualifications - For full consideration, applicants are encouraged to upload license and/or certification if required of the position

• Valid California Registered Nurse License.
• Bachelor's in Nursing is required.
• Minimum 5 years HMO/Utilization Management experience with capitated plans.
• Ability to organize and direct varied health care teams in a manner that establishes a good rapport and professional working relationship.
• Ability to work efficiently and independently in a calm manner, under pressure.
• Ability to organize work to accommodate special projects, deadlines and priorities.
• Leadership skills to direct others of varying job levels to accomplish tasks in a positive manner that are conducive to positive outcomes.
• Skill to assess learning needs of staff and to participate in their training development to promote growth within their position and the university.
• Written communication skills to clearly and concisely compose letters, performance evaluations, reports, policies and procedures that could include clinical, financial and administrative information.
• Verbal communication skills to clearly and concisely receive, elicit, and convey information of a clinical, financial, or administrative nature to a variety of individuals within and outside the university.
• Knowledge of University Personnel policies and procedures and various employee bargaining unit contracts.
• Ability to work with all levels of staff, both inter- and intra-departmentally to create cooperative relationships and positive working environment.

Preferred Qualifications

• Masters Degree is preferred.
• Additional preferred experience in appeals/grievance management, case management and network management.
• Broad-based clinical experience.
• Knowledge of California HMO statutes and regulations, procedures and regulations regarding benefits, services and restrictions in relation to both utilization management and continuity of care, specifically the Knox Keene Act.
• Skills applying National Committee for Quality Assurance UM standards to an HMO product.
• Knowledge of Epic.

Key Responsibilities

• 30% - Responsibility Delegated Utilization Management
• 60% - Managed Care and Utilization Management Unit Operations
• 5% - Committee Membership
• 5% - Professional Development

POSITION INFORMATION

• Salary or Pay Range: $129000.00 - $294000.00
• Salary Frequency: Monthly
• Salary Grade: Grade 28
• UC Job Title: UTILIZATION MGT MGR 2
• UC Job Code: 006833
• Number of Positions: 1
• Appointment Type: Staff: Career
• Percentage of Time: 100
• Shift (Work Schedule): Monday - Friday
• Location: UCDHAS Building (HSP165)
• Union Representation: 99 - Non-Represented (PPSM)
• Benefits Eligible: Yes
• This position is hybrid (mix of on-site and remote work)

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

* High quality and low-cost medical plans to choose from to fit your family's needs
* UC pays for Dental and Vision insurance premiums for you and your family
* Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave
* Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Access to free professional development courses and learning opportunities for personal and professional growth
* WorkLife and Wellness programs and resources
* On-site Employee Assistance Program including access to free mental health services
* Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage
* Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles
* Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here
* UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff

Physical Demands

• Standing - Occasional Up to 3 Hours
• Walking - Occasional Up to 3 Hours
• Sitting - Frequent 3 to 6 Hours
• Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
• Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
• Bending/Stooping - Occasional Up to 3 Hours
• Squatting/Kneeling - Occasional Up to 3 Hours
• Twisting - Occasional Up to 3 Hours
• Reaching overhead - Occasional Up to 3 Hours
• Keyboard use/repetitive motion - Frequent 3 to 6 Hours

Mental Demands

• Sustained attention and concentration - Frequent 3 to 6 Hours
• Complex problem solving/reasoning - Occasional Up to 3 Hours
• Ability to organize & prioritize - Frequent 3 to 6 Hours
• Communication skills - Frequent 3 to 6 Hours
• Numerical skills - Occasional Up to 3 Hours
• Constant Interaction - Frequent 3 to 6 Hours
• Customer/Patient Contact - Frequent 3 to 6 Hours
• Multiple Concurrent Tasks - Frequent 3 to 6 Hours

Work Environment

UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.

Employee must be able to work occasional overtime and/or flexible hours as needed by the department.

Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

• This is a critical position, as defined by UC Policy and local procedures, and as such, employment is contingent upon clearing a criminal background check(s) and may include drug screening, medical evaluation clearance and functional capacity assessment
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/PPSM-20

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere

To learn more about our background check program, please visit: https://hr.ucdavis.edu/departments/recruitment/ucd/selection/background-checks