Supervisor, Utilization Management

About Our Company

At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Clinical team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 4,000+ physicians, working in over 40 cities in California, caring for more than 500,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.

This position is located in our brand-new Oakland City Center location, or remotely (within the state of California). We are flexible provided you are open to traveling to the Oakland office locations as needed. You must reside in the state of California.

About Your Work

The Supervisor, Utilization Management will be a content expert and resource for all clinical data and criteria used for prior authorization. The supervisor role will lead the Utilization Management team in ongoing training, ensuring regulatory requirements are being met, and driving team engagement. Under direction of the Director, Medical Management, assists in short and long-range program planning, process improvement, and management of the Clinical Services division. Provides analysis and reporting on clinical performance. Prepares department for internal and external audits; conducts Utilization Management delegation audits and develops policies and procedures for adherence to governmental and accredited agency standard. The successful candidate will oversee and participate in the development and implementation of effective and efficient standards, policies, protocols, processes, reports and benchmarks that support and further enhance Utilization Management and timely access to care the support the strategic mission of Altais.

You will focus on:

• Supervises and coordinates activities of utilization review staff in maintenance of informed policy and procedure manuals, files, records and correspondence.
• Provide guidance on issues related to referral and authorization process, benefits interpretation, and other utilization issues.
• Provide Clinical Oversight for the Utilization Management Functions by evaluating effectiveness and determining the efficiency of ongoing projects in the workplace.
• Provide medical direction and drives quality and process improvement efforts for the functions and activities related to the authorization of eligible medical services, referral authorization activities, and referral authorization staff.
• Facilitates recruitment, selection, orientation and staff training, coaching and development. Communication of staff performance and conducts annual performance evaluations.
• Advising and coaching team members by providing guidance on operational/project issues, key success factors of the project, and lessons learned. Set clear expectations for team members, including defining what they should do on a daily and project level basis.
• Actively engages with the Management Leadership Team to define and measure goals for organizational/departmental performance and determines/develops the tasks and resources needed to attain them.
• Lead and directs the development, implementation, and evaluation of care management programs, policies and procedures and programs as part of annual strategic initiatives and reporting.
• Manage internal and external stakeholder relationships and partnering with different departments as needed to work cross functionally and deliver on the initiatives. Work closely with the stakeholders to establish priorities, areas of concern and implementation plan. Establish technical/stakeholder forums as required to brainstorm, resolve and provide transparency on issues proactively
• Manage and/or lead project role assignments, prioritizing, and communicating to the team and stakeholders proactively. Escalating regularly on project/operational issues as needed.
• Manages relationship and communication external stakeholders and health plans.

The Skills, Experience & Education You Bring

• Current RN or LVN license in the state of California
• Bachelor’s Degree in Nursing (BSN) preferred
• 3+ years of medical group or health plan Utilization Management experience
• Demonstrate strong ability to manage, prioritize, and delegate multiple assignments or tasks with potentially conflicting deadlines, desire to seek out additional assignments or tasks, and to help others.
• Demonstrate strong ability to communicate with physicians and other internal and external stakeholders to provide medical management for incoming authorization requests and specialist referrals using nationally recognized guidelines to determine medical necessity.
• Demonstrated strong problem-solving skill by seeking, logically examining, and interpreting information from different sources to determine a problem's cause and developing a course of action to resolve the problem and to prevent its recurrence.
• Demonstrated strong ability to perform utilization review activities per CMS, Health Plan, and NCQA requirements.

You Share Our Mission & Values:

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.