Founded in 1978,Â Universal Health Services, Inc. (UHS)* is one of the nationâ€™s largest and most respected healthcare management companies, operating through its subsidiariesâ€"acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHSâ€™s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHSâ€™s well-reputed franchise with itsÂ customaryÂ exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortuneâ€™s Most Admired Companies. UHSâ€™s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care.Â
Prominence Health Plan, established in Reno in 1993 as St. Maryâ€™s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies.Â
In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.
We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.
Essential Duties: The Clinical Manager of Medical Management is responsible for overseeing all clinical employee efforts that are designed to control medical management of Prominence Health Plan Members.Â This Manager ensures that contracted facilities and providers are honoring the terms of their agreements with Prominence Health Plan to eliminate overutilization, and is responsible for formulating decisions on coverage determinations on inpatient and outpatient utilization to be reviewed and approved by senior medical personnel.Â The employee ensures that the processes for utilization management are precise and timely, and that the people who administer them do so with rigor and intensity meeting all regulatory protocols.Â The desired end state is high-quality healthcare that conforms to expected metrics for well-managed health plans, especially in terms of bed day utilization.Â In particular, the employee will devote all of his or her energy to manage utilization using traditional tools as well as devise innovative ways to create better outcomes.