Director Utilization Management
1 week 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.
Basic Qualifications:Experience
- Minimum three (3) years of experience in directing utilization management and discharge planning in an acute care setting.
Education
- 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
4 days ago
Los Angeles, California, United States Management Business Solutions Full timeJob Title: Utilization Management DirectorManagement Business Solutions is seeking a highly skilled Utilization Management Director to join our team. As a key member of our healthcare operations team, you will be responsible for managing the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center.Key...
-
Utilization Management Program Director
2 weeks ago
Los Angeles, California, United States Management Business Solutions Full timeJob Title: Utilization Management Program DirectorManagement Business Solutions is seeking a highly skilled Utilization Management Program Director to lead our team in providing exceptional patient care and ensuring cost-effective utilization of resources.Key Responsibilities:Develop and maintain policies and procedures for Utilization ManagementCollaborate...
-
Director of Utilization Management
3 weeks ago
Los Angeles, California, United States healthcarerecruitmentpartners Full timeDirector of Utilization ManagementThe Director of Utilization Management plays a pivotal role in overseeing the Case Management and Utilization Review program. This individual is responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions such as Discharge...
-
Utilization Management Director
1 day ago
Los Angeles, California, United States APLA Health Full timeJob SummaryWe are seeking a highly skilled Utilization Management Director to join our team at APLA Health. As a key member of our healthcare operations team, you will be responsible for managing the daily operations of Utilization Management (UM) at APLA Health and Wellness (APLAHW).Key ResponsibilitiesDevelop and implement a standardized Utilization...
-
Outpatient Utilization Manager
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob SummaryWe are seeking a highly skilled Outpatient UM Clinician to join our team at MedPOINT Management. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesReview and process precertification requests for medical necessity,...
-
Director of Utilization Management
4 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Key...
-
Utilization Management Director
11 hours ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of the Kaiser Permanente team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of...
-
Director of Utilization Management
3 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Key...
-
Utilization Management Program Director
4 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:As a key member of the Kaiser Permanente team, the Utilization Management Program Director plays a vital role in ensuring cost-effective and quality patient care. This position oversees the day-to-day operations of the Utilization Management Program, collaborating with multidisciplinary teams to plan and coordinate care across the continuum. The...
-
Los Angeles, California, United States Healthcare Recruitment Partners Full timeJob SummaryHealthcare Recruitment Partners is seeking a highly skilled Director of Utilization Management and Case Coordination to lead our team in Los Angeles, California. As a key member of our organization, you will be responsible for directing the Case Management and Utilization Review program, developing and managing programs that emphasize appropriate...
-
Utilization Management Program Director
4 weeks ago
Los Angeles, California, United States Recruitics JB Full timeJob Summary:As a key member of the Recruitics JB team, we are seeking a skilled Utilization Management Program Director to lead our Utilization Management Program in the Service Area or a Medical Center. This role is responsible for ensuring cost-effective and quality patient care by appropriate utilization of resources. The ideal candidate will provide...
-
Utilization Management Program Director
3 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:As a key member of the Kaiser Permanente team, the Utilization Management Program Director will oversee the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. This role is responsible for ensuring cost-effective and quality patient care by appropriate utilization of resources. The successful...
-
Director of Case Management
3 weeks ago
Tracy, CA, United States Clinical Management Consultants Full timeA new opportunity has become available for a Director of Case Management at a 500+ bed highly accredited facility in central California. This is a very large role that is in need of someone that will be dedicated to the department as well as the hospital's goals and values. The Director of Case Management plays a crucial role in overseeing and managing...
-
Director, Commercial Utilization Management
2 months ago
United States, CA, Rancho Cordova Blue Shield of California Full timeYour Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of Utilization Management team in delivering and...
-
Director, Commercial Utilization Management
2 weeks ago
Rancho Cordova, CA, United States Blue Shield of California Full timeYour Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of Utilization Management team in delivering and...
-
Director, Commercial Utilization Management
1 month ago
Rancho Cordova, CA, United States Blue Shield of California Full timeYour Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of Utilization Management team in delivering and...
-
Director of Utilization Management
1 week ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryDevelops, manages, and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions, concurrent, and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization...
-
Healthcare Manager
4 days ago
Los Angeles, California, United States Management Business Solutions Full timeJob SummaryManagement Business Solutions is seeking a skilled Healthcare Manager to lead our Utilization Management Program. As a key member of our team, you will be responsible for managing the day-to-day operations of the program, ensuring cost-effective and quality patient care through appropriate resource utilization.Key Responsibilities:Develop and...
-
Utilization Management Specialist
3 weeks ago
Los Angeles, California, United States APLA Health Full timeJob SummaryThis is a challenging and rewarding role that requires a strong background in healthcare operations and management. As a Utilization Manager at APLA Health, you will be responsible for overseeing the daily operations of our Utilization Management (UM) program, ensuring that all processes and programs are fully implemented and compliant with...
-
Director Utilization Management
2 weeks ago
Los Angeles, 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...