Director Utilization Management
3 months ago
Develops, manages and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization Review program, Transportation coordination and Extended Care Coordination to promote a centralized, coordinated, interdisciplinary process in the continuum of care.
Essential Responsibilities:
- Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Service Areas or Medical Centers utilization goals while maintaining customer satisfaction.
- Acts as a resource to the medical staff, administrative staff, divisional, SCPMG, TPMG and external regulatory agencies in all issues relating to utilization management within the Service Area or Medical Center.
- Oversees outside medical services based on Health Plan benefit guidelines and medical necessity.
- Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
- May direct the operations of outside referrals/transportation services.
- May serve as contract liaison for the Service Area or Medical Center on issues pertaining to new or existing contracts with outside vendors.
- Develops, monitors and controls departments budgets.
- Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
- Hires, coaches, trains and disciplines staff to ensure smooth operations in utilization management.
- Also facilitates educational training for medical staff on issues related to utilization management.
- Minimum three (3) years of experience in directing utilization management and discharge planning in an acute care setting.
- BSN or bachelors degree in healthcare related field such as management, health services administration.
- Registered Nurse License (California)
- Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, Medi-Cal and other local, state and federal regulations.
- Knowledge of managed care operations.
- Demonstrated interpersonal, negotiation, and leadership skills.
- Effective oral and written communication skills.
- Must be able to work in a Labor/Management Partnership environment.
- Masters degree in a related field such as nursing, business or health services administration preferred.
-
Utilization Management Director
6 days ago
Los Angeles, California, United States Healthcare Recruitment Partners Full timeJob OverviewThe Utilization Management Director balances individual patient and family needs with cost-effective utilization of resources. This role requires strong leadership skills and the ability to collaborate with an interdisciplinary team.Key Responsibilities:Assesses patients to determine the appropriateness of their level of care.Develops and...
-
Utilization Management Director
1 month ago
Los Angeles, California, United States Kaiser Permanente Full timeJob DescriptionWe are seeking a highly skilled Utilization Management Director to join our team at Kaiser Permanente.Job Summary:The ideal candidate will have extensive experience in directing utilization management and discharge planning in an acute care setting. This role is responsible for developing, managing, and directing the Utilization Management...
-
Outpatient Utilization Management Specialist
4 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewThe MedPOINT Management team is seeking an experienced Outpatient UM Clinician to join our team. This role is responsible for ensuring a thorough review of outpatient precertification/preauthorization referrals for members requiring outpatient services.In close collaboration with the Medical Director, the successful candidate will work towards...
-
Outpatient Utilization Manager
5 days ago
Los Angeles, California, United States MedPOINT Management Full timeJob Summary: We are seeking a detail-oriented and organized Clinical Coordination Specialist to join our team at MedPOINT Management. In this role, you will be responsible for coordinating clinical activities, communicating with healthcare providers, and maintaining accurate records of patient information.About the Role:The Clinical Coordination Specialist...
-
Utilization Management Director
1 month ago
Los Angeles, California, United States Kaiser Permanente Full timeWe are seeking an experienced Clinical Operations Leader to join our team at Kaiser Permanente. This is a leadership role that requires strong management skills, knowledge of healthcare operations, and excellent communication skills.Job Summary:This position oversees the Utilization Management programs in a Service Area or Medical Center, ensuring compliance...
-
Case Management Director
1 week ago
Los Angeles, California, United States MedPOINT Management Full timeJob SummaryMEDPOINT MANAGEMENT is seeking a seasoned Case Management Director to lead our inpatient transplant program. In this critical role, you will oversee the development and implementation of strategies to improve patient outcomes, streamline processes, and enhance the overall quality of care.Your expertise in case management, leadership, and strategic...
-
Los Angeles, California, United States Rincon Consultants, Inc Full timeOverviewRincon Consultants, Inc. is a leading environmental consulting firm with 13 offices across California.Job SummaryWe are seeking an experienced Director/Principal to lead our Renewables and Utilities services, managing client relationships, overseeing internal teams, and driving business development in the Energy and Utilities market.Key...
-
Medical Case Manager
6 days ago
Los Angeles, California, United States MedPOINT Management Full timeWe are seeking a skilled Medical Case Manager to join our team at MedPOINT Management.As an Outpatient Utilization Specialist, you will play a crucial role in ensuring the quality and efficiency of our healthcare services.The estimated salary for this position is between $42,000 and $48,000 per year, depending on experience and qualifications.About the...
-
Los Angeles, United States Martin Luther King Jr. Community Hospital Full timeThe expected schedule is two days per week, twice a month. No weekends. If you are interested please apply online and send your resume to norozco@mlkch.org POSITION SUMMARY The Utilization Management Physician Advisory (PA) is a physician with a broad base of clinical experiences who acts as a liaison between the hospital administration, clinical staff, and...
-
Director of Facilities Management
5 days ago
Los Angeles, California, United States UOVO Full timeAbout the RoleWe are looking for a seasoned Facilities Director to lead our facilities team at UOVO. As Associate Director of Facilities, you will oversee all aspects of facility operations, including budget management, capital planning, and project coordination.The successful candidate will have a strong background in facilities management, with experience...
-
Director Utilization Management
4 weeks ago
Los Angeles, CA, United States Kaiser Permanente Full timeJob Summary: Develops, manages and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside...
-
Utilization Management Physician Advisor Part-Time
2 months ago
Los Angeles, United States MLK Community Healthcare Full timeThe expected schedule is two days per week, twice a month. No weekends. If you are interested please apply online and send your resume to norozco@mlkch.org POSITION SUMMARY The Utilization Management Physician Advisory (PA) is a physician with a broad base of clinical experiences who acts as a liaison between the hospital administration, clinical staff, and...
-
Residential Property Manager Director
6 days ago
Los Angeles, California, United States ConAm Management Corporation Full timeJob ResponsibilitiesThe Residential Property Manager Director is responsible for overseeing the overall performance of a multi-family residential community. This includes managing daily operations, maintaining fiscal and physical soundness, and providing exceptional customer care and service.This role requires strong leadership and customer service skills,...
-
ASC Supply Chain Manager
3 weeks ago
Los Angeles, United States Clinical Management Consultants Full timeJob DescriptionThis trusted and established Ambulatory Surgery Center (ASC) is actively interviewing for a Supply Chain Manager to join its experienced ASC Leadership team.Reporting to the Regional Director of Operations, the Materials / Supply Chain Manager will play a significant role in the daily and strategic operations of three busy outpatient surgery...
-
ASC Supply Chain Manager
4 weeks ago
Los Angeles, United States Clinical Management Consultants Full timeThis trusted and established Ambulatory Surgery Center (ASC) is actively interviewing for a Supply Chain Manager to join its experienced ASC Leadership team.Reporting to the Regional Director of Operations, the Materials / Supply Chain Manager will play a significant role in the daily and strategic operations of three busy outpatient surgery centers. Working...
-
Utilization Review Specialist
5 days ago
Los Angeles, California, United States Los Angeles LGBT Center Full timeAbout the RoleThe Los Angeles LGBT Center is seeking a highly skilled Specialty Referral Services Director to oversee the coordination and management of referrals from primary care to specialty care providers while ensuring adherence to utilization review standards.Salary: $87,879-$92,761 annuallyKey ResponsibilitiesDevelop and refine workflows to improve...
-
Electric Utility Construction Director
6 days ago
Los Angeles, California, United States PM2CM Full timeAbout the RoleWe are currently seeking an experienced Construction Manager to lead our electric utility construction team at PM2CM. As a key member of our team, you will be responsible for planning, coordinating, and supervising the construction of electrical infrastructure projects, including overhead and underground distribution lines, substations, and...
-
Utilization Management Specialist
4 weeks ago
Los Angeles, United States UCLA Health Full timeDescription Under the direction and supervision of the Utilization Management Manager, the Utilization Management Specialist is responsible for overseeing the research, resolution and workflow development of out-of-network (OON) referral requests. This role reviews OON referral requests from members and providers, acting as a key liaison to facilitate...
-
Transplant Case Manager
2 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob Title: Transplant Case ManagerCompany Overview:At MedPOINT Management, we are committed to providing exceptional healthcare services to our patients. As a Transplant Case Manager, you will play a vital role in ensuring the seamless coordination of transplant care for our patients.Job Summary:We are seeking an experienced RN or LVN to join our team as a...
-
Client Relationship Director
2 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeAbout the JobWe are seeking an experienced Client Relationship Director to lead our account management efforts.As a key member of our team, you will be responsible for managing multiple priorities, collaborating with cross-functional teams, and driving business growth.With a competitive salary range of $120,000 - $180,000 per year, you will have the...
