Manager Utilization Management
3 months ago
Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others as assigned.
Essential Responsibilities:
- Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management.
- Collaborates with the multi-disciplinary teams to plan and coordinate care across the continuum.
- Coordinates and manages members care with non-KFH hospital facilities and providers. Identifies risk management and quality of care issues across the continuum.
- Surfaces issues and any suggestions to the appropriate multi-disciplinary team members.
- Manages transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs.
- Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
- Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.
- Assists in conducting statistical studies in utilization trends, patterns, and outcomes.
- Hires, trains coaches, disciplines professional and clerical support staff.
Basic Qualifications:
Experience
- Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
Education
- BSN or bachelors degree in healthcare related field such as management, health services administration.
License, Certification, Registration
- Registered Nurse License (California)
Additional Requirements:
- Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, MediCal and other local, state and federal regulations.
- Knowledge of managed care operations.
- Demonstrated interpersonal, negotiation, and management skills.
- Good oral and written communication skills.
- Must be able to work in a Labor/Management Partnership environment.
Notes:
- Rotating On-Call Weekends
-
Outpatient Utilization Management Specialist
1 week ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewPosition: Outpatient Utilization Management Specialist at MedPOINT ManagementRole SummaryThe Outpatient Utilization Management Specialist is essential in enhancing communication between Managed Services Organizations (MSO), Independent Physician Associations (IPA), and members to guarantee seamless member care. Key responsibilities include...
-
Outpatient Utilization Management Coordinator II
2 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewThe Outpatient Utilization Management Coordinator serves as the primary liaison between the Outpatient Utilization Management (UM) team and Health Plan representatives. This position is responsible for managing referral requests directed to Health Plans, including but not limited to tertiary care, durable medical equipment, and pharmacy services,...
-
Manager Utilization Management
3 weeks ago
Los Angeles, United States Kaiser Permanente Full timeJob Summary: Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others...
-
Manager of Utilization Management
1 month ago
Los Angeles, United States Pivotal Placement Services, Inc Full timeManager, Utilization Management This is a full-time permanent opportunity with a large hospital system. Ensures cost-effective and quality patient care by appropriate utilization of resources. Provides direction to staff, including Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and others as assigned.We are looking for...
-
Manager of Utilization Management
1 month ago
Los Angeles, United States Pivotal Placement Services, Inc Full timeManager, Utilization Management This is a full-time permanent opportunity with a large hospital system. Ensures cost-effective and quality patient care by appropriate utilization of resources. Provides direction to staff, including Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and others as assigned.We are looking for...
-
Utilization Management Supervisor
2 weeks ago
Los Angeles, California, United States Lincoln Search Consultants Inc Full timeManager, Utilization Management Location: Los Angeles, CA, US Compensation: $165,000 - $175,000 + Bonus + SIGNING BONUS + Paid Relocation *RN Required* On-Call Rotation Required The Manager of Utilization Management oversees the daily functions of the Utilization Management Program within the designated Service Area or Medical Center. This role is pivotal in...
-
Utilization Management Nurse
4 days ago
Los Angeles, United States Presidential Staffing Solutions, LLC Full timeBenefits: 401(k) Competitive salary Dental insurance Health insurance Paid time off Signing bonus Training & development Vision insurance Outpatient Case Management West Los Angeles VAMC 11301 Wilshire Blvd Los Angeles, CA. 90073 There are five new RN vacancies at the West Los Angeles VA Medical Center. Service Line | Unit | Position Title | Tour | Qualified...
-
Pharmacy Utilization Manager
2 weeks ago
Los Angeles, California, United States CEDARS-SINAI Full timePosition OverviewAt Cedars-Sinai, we understand that the work we do has a profound effect on the well-being of individuals. Our commitment to excellence is reflected in our six consecutive Magnet designations for nursing quality. By joining our team of distinguished healthcare professionals and utilizing cutting-edge facilities, you will have the opportunity...
-
Utilization Management Nurse
7 days ago
Los Angeles, United States Presidential Staffing Solutions, LLC Full timeJob DescriptionJob DescriptionOutpatient Case ManagementWest Los Angeles VAMC11301 Wilshire BlvdLos Angeles, CA. 90073There are five new RN vacancies at the West Los Angeles VA Medical Center. Service Line | Unit | Position Title | Tour | Qualified Contractor | VendorHOSPITAL OPERATIONS | INPATIENT | RN | 0630-1500 | Vacant | OpenHOSPITAL OPERATIONS |...
-
Utilization Management Nurse
6 days ago
Los Angeles, United States Presidential Staffing Solutions, LLC Full timeJob DescriptionJob DescriptionBenefits:401(k)Competitive salaryDental insuranceHealth insurancePaid time offSigning bonusTraining & developmentVision insurance Outpatient Case ManagementWest Los Angeles VAMC11301 Wilshire BlvdLos Angeles, CA. 90073There are five new RN vacancies at the West Los Angeles VA Medical Center.Service Line | Unit | Position Title |...
-
Senior Manager
5 days ago
Los Angeles, California, United States Exponent Full timeAbout ExponentWe are a leading engineering and scientific consulting firm with a unique blend of expertise and experience. Our team of experts provides innovative solutions to complex challenges, empowering our clients to create a safer, healthier, and more sustainable world.Our OpportunityWe are seeking a Senior Manager to join our Construction Consulting...
-
Physician Advisor
5 days ago
Los Angeles, California, United States MLK Community Healthcare Full timeJob SummaryMLK Community Healthcare is seeking a highly skilled Physician Advisor to join our team in Utilization Management. As a key member of our care coordination team, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesCollaborate with Care Management Team: Work closely with our care...
-
Case Manager Utilization RN
3 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryKaiser Permanente is seeking a skilled Case Manager Utilization RN to join our team. As a key member of our healthcare team, you will play a critical role in coordinating and managing the care of our patients.Key ResponsibilitiesCollaborate with Physicians: Work closely with physicians to develop and implement individualized plans of care that...
-
Clinical Utilization Management Advisor
2 weeks ago
Los Angeles, California, United States MartinLutherKingJrCommunityHospital Full timePosition OverviewThe Clinical Utilization Management Advisor (CUMA) serves as a vital link among hospital administration, clinical personnel, and support teams. This role encompasses part-time inpatient duties in utilization management and care coordination while also maintaining a portion of inpatient patient care responsibilities. The expectation is for...
-
Utilization Management Physician Advisor
1 month ago
Los Angeles, United States MLK Community Healthcare Full timeJob DescriptionJob DescriptionJob DescriptionIf you are interested please apply online and send your resume to norozco@mlkch.orgThe expected schedule is a Wednesday, Thursday, Friday twice a month. POSITION SUMMARYThe Utilization Management Physician Advisory (PA) is a physician with a broad base of clinical experiences who acts as a liaison between the...
-
Clinical Utilization Management Advisor
2 weeks ago
Los Angeles, California, United States Martin Luther King Jr. Community Hospital Full timePosition Overview:The Clinical Utilization Management Advisor serves as a crucial link among hospital management, healthcare professionals, and support teams. This role requires a physician with extensive clinical expertise who can effectively navigate the complexities of patient care.Key Responsibilities:1. Collaborate with clinical staff to ensure optimal...
-
Utilization Management Nurse Specialist
5 days ago
Los Angeles, California, United States Presidential Staffing Solutions, LLC Full timeJob SummaryWe are seeking a highly skilled Utilization Management Nurse to join our team at Presidential Staffing Solutions, LLC. As a Utilization Management Nurse, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesReview patient files and treatment information to identify opportunities for...
-
Utilization Management Nurse Specialist
5 days ago
Los Angeles, California, United States Presidential Staffing Solutions, LLC Full timeJob SummaryWe are seeking a highly skilled Utilization Management Nurse to join our team at Presidential Staffing Solutions, LLC. As a Utilization Management Nurse, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesReview patient files and treatment information to identify opportunities for...
-
Pharmacy Utilization Manager
2 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeJob Overview At Cedars-Sinai, the work you engage in daily significantly influences the well-being of others. Every effort, detail, and moment counts. This culture of commitment and enthusiasm is part of what has earned us six consecutive Magnet designations for nursing excellence. Collaborating with a team of leading healthcare professionals and utilizing...
-
Utilization Management Physician Advisor
1 month ago
Los Angeles, United States Martin Luther King Jr. Community Hospital Full timeThe 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 support personnel. The PA position has part-time inpatient resp Physician, Management, Advisor, Medical Director, Patient Care, Staff, Healthcare