Current jobs related to Director of Utilization Management - Bakersfield - Kern Health Systems
-
Director of Utilization Management
3 days ago
Bakersfield, California, United States Impresiv Health Full timeJob Title: Director of Utilization ManagementAt Impresiv Health, we are seeking a highly skilled and experienced Director of Utilization Management to join our team. As a key member of our healthcare consulting team, you will be responsible for providing comprehensive oversight of the Utilization Review process and ensuring that our clients receive...
-
Director of Utilization Management
1 month ago
Bakersfield, United States Impresiv Health Full timeTitle: Director of Utilization Management Duration: Direct Placement Location: Bakersfield, CA Summary: The Director of Utilization Management (UM) provides comprehensive oversight of the Utilization Review process. The position integrates and coordinates services using continuous quality improvement initiatives to promote positive...
-
Utilization Management Director
3 weeks ago
Bakersfield, California, United States Impresiv Health Full timeImpresiv Health is seeking a highly motivated and experienced Utilization Management Director to lead our team in ensuring efficient and effective healthcare delivery. As a key member of our leadership team, you will play a vital role in developing and implementing strategies that optimize resource utilization, enhance patient care outcomes, and drive...
-
Medical Director of Utilization Management
1 week ago
Bakersfield, California, United States CommonSpirit Health Full time{"title": "Medical Director of Utilization Management", "content": "Job SummaryWe are seeking a highly skilled Medical Director of Utilization Management to join our team at CommonSpirit Health. As a key member of our leadership team, you will be responsible for providing clinical expertise and business direction in support of medical management programs...
-
Chief of Utilization Oversight
3 weeks ago
Bakersfield, California, United States Impresiv Health Full timePosition: Director of Utilization Management Employment Type: Direct Placement Location: Bakersfield, CA Overview: The Director of Utilization Management (UM) is responsible for the comprehensive administration of the Utilization Review process. This role involves the integration and coordination of services through continuous quality...
-
Vice President of Utilization Oversight
4 weeks ago
Bakersfield, California, United States Impresiv Health Full timeTitle: Director of Utilization Management Duration: Direct Placement Location: Bakersfield, CA Overview:The Director of Utilization Management (UM) plays a pivotal role in supervising the Utilization Review process. This position is responsible for integrating and coordinating services through continuous quality improvement initiatives aimed at enhancing...
-
Program Director
4 months ago
Bakersfield, United States Integrated Practice Management LLC Full timeJob DescriptionJob DescriptionDescription:Under the general supervision of the Chief Nursing Officer, the Program Director provides clinical/ guidance, support and development to the therapists, interns, addiction counselors, unlicensed case managers and mental health team. To provide insight, guidance, and leadership in developing and maintaining a...
-
Dish Machine Operator/Utility
2 weeks ago
Bakersfield, California, United States Outback Steakhouse Matilda Management Full timeAbout Outback Steakhouse / Matilda ManagementWe are a leading restaurant group, committed to delivering exceptional dining experiences to our customers. Our team is passionate about providing top-notch service and quality food, while maintaining a fun and respectful work environment.Job SummaryWe are seeking a highly motivated and detail-oriented Dish...
-
Director of Care Coordination
2 weeks ago
Bakersfield, California, United States Dignity Health Full timeAbout the RoleThe Director of Utilization Management is a senior leadership position responsible for overseeing the day-to-day operations of the utilization management nursing teams at Dignity Health. This role is critical in ensuring the efficient and effective management of healthcare services, while maintaining high-quality patient care.Key...
-
Director of Care Coordination
1 week ago
Bakersfield, California, United States Dignity Health Full timeAbout the RoleThe Director of Utilization Management is a senior leadership position responsible for overseeing the day-to-day operations of the utilization management nursing teams. This includes preservice utilization review, concurrent inpatient review, and retro claim review.Key ResponsibilitiesLead the utilization management nursing teams in the...
-
Utilization Review Nurse
4 weeks ago
Bakersfield, United States Kern Medical Full timeKern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services...
-
Utilization Review Nurse
3 months ago
Bakersfield, United States Kern Medical Full timeKern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles.Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services integrated...
-
Utilization Review Nurse
2 weeks ago
Bakersfield, California, United States Kern Medical Full timeJob SummaryKern Medical is seeking a highly skilled Utilization Review Nurse - Case Management to join our team. As a key member of our healthcare organization, you will play a critical role in ensuring the efficient use of hospital resources while providing exceptional patient care.Key ResponsibilitiesConduct thorough medical record reviews to determine the...
-
Clinical Utilization Reviewer
4 days ago
Bakersfield, California, United States Universal Healthcare MSO LLC Full timeJob SummaryWe are seeking a skilled UM Nurse Reviewer to join our team at Universal Healthcare MSO LLC. 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 ResponsibilitiesConduct timely reviews of pre-certification and concurrent requests, aligning...
-
IT Project Management Director
1 week ago
Bakersfield, California, United States InsideHigherEd Full timeJob SummaryWe are seeking an experienced IT Project Management Director to lead our IT project management office and oversee the management of our IT project portfolio. The successful candidate will have a strong background in IT project management, excellent leadership and communication skills, and the ability to drive successful project planning and...
-
Enterprise Applications Director
1 week ago
Bakersfield, California, United States InsideHigherEd Full timeJob SummaryWe are seeking an experienced Associate Director of Enterprise Applications to join our team at Kern Community College District. The successful candidate will be responsible for overseeing the planning, development, maintenance, integration, and enhancement of our Enterprise Resource Planning (ERP) systems and related applications.Key...
-
IT Project Management Director
7 days ago
Bakersfield, California, United States InsideHigherEd Full timeJob SummaryWe are seeking an experienced IT Project Management Director to lead our IT project management office and oversee the management of our IT project portfolio. The successful candidate will have a strong background in IT project management, excellent leadership and communication skills, and the ability to drive successful project planning and...
-
Medical Director
1 week ago
Bakersfield, California, United States Kernfamilyhealthcare Full timeJob DescriptionCompany OverviewKern Family Health Care is a leading healthcare organization dedicated to improving the health status of our members through an integrated managed healthcare delivery system.Job SummaryWe are seeking a highly experienced and skilled Medical Director to provide clinical leadership and guidance in the development and measurement...
-
Director of Social Services
2 hours ago
Bakersfield, California, United States Telecare Full timeJob SummaryThe Director of Social Services is a key leadership position at Telecare, responsible for planning, implementing, and directing the Social Services Department. This department provides casework services to members served and their families, and the Director must ensure that these services are delivered in a safe and therapeutically effective...
-
Associate Director, Enterprise Applications
7 days ago
Bakersfield, California, United States InsideHigherEd Full timeJob SummaryWe are seeking an experienced Associate Director, Enterprise Applications to join our team at InsideHigherEd. The successful candidate will be responsible for overseeing the planning, development, maintenance, integration, and enhancement of our Enterprise Resource Planning (ERP) systems and related applications.Key ResponsibilitiesProvide...
Director of Utilization Management
3 months ago
KHS reasonably expects to pay starting compensation for the position of Director of Utilization Management in the range of $153,597 - $199,676 annually.
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
About the role
The Director of Utilization Management (UM) provides comprehensive oversight of the Utilization Review process under the Knox Keene license and Department of Health Care Services contract. The position integrates and coordinates services using continuous quality improvement initiatives to promote positive member outcomes. Frequent executive level reporting and tracking on department and individual team productivity is essential. The Director of UM assesses needs, plans, communicates, designs services and strategies to forward the mission and serve member needs. The Director provides strategic leadership, development, and supervision to utilization review department, provides inter-professional collaboration with facility-based case managers and discharge planners, and coordinates with all aspects of the Kern Health Systems functions, including Claims and Member Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals.
Under the direction of the Utilization Management Medical Director, and in collaboration with the Chief Medical Officer, Sr. Director of Health Services, and the Director of UM assists in coordinating clinical functions and programs which effectuate and support KHS medical policy according to contractual requirements, and in developing and implementing new clinical programs to manage costs and ensure quality care delivery. The position will be an essential contributor to the development, implementation, and monitoring of the medical management strategy and ongoing process improvement.
Essential
**Responsibilities**:
- Oversees formal utilization and network coordination services. Provides operational oversight and recommends corrective action for all shared services
- Manages the UM results, including referral management; acute, SNF and Rehab admissions
- Continually creates and implements strategies to improve organizational and UM Departments performance
- Participates in contracted provider network meetings to enhance communication and continuity of member care services
- Has management responsibility as assigned for the key Medical Management Programs, Coordinated Care, DME, Ancillary services, and Pharmaceutical collaboration
- Participates in determination of department’s goals and objectives, setting organizational structure, staffing, and space planning
- Participates in recruitment, retention, and training of UM Management staff.
- Acts as a resource to other departments in regard to Case Management, Disease Management,
Health Education, Quality Improvement, Compliance, Provider Network Management, and Claims
- Collaborates with Executive leadership of Medical Management, Medical Directors, UM Management, and other staff as well as other departmental peers
- Program Development, Implementation and Evaluation
- Conduct needs assessment including development of methods for determining potential patient enrollment, medical literature review, analysis of pre-program utilization and return on investment
- Development and Implementation of the UM Program to include establishment of policies and procedures, enrollment strategies, member and physician materials, and measurements of program outcome
- Evaluate staff educational needs and coordinate training
- Analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
- Knowledge of Milliman Care Guidelines (MCG), InterQual Criteria, MCAL and CMS Criteria
- Knowledge of managed care health plans operations and HIPAA guidelines
- Experience and knowledge in intermediate computer skills (i.e. Microsoft Word, Excel)
- Leads and participates in cross functional corporate teams which design and implement new population management programs
- Develops and implements process and program redesigns.
- Leads multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.
- Ability to utilize multiple technology systems for documentation and coordination of services.
- Ensures adherence to all contract, regulatory and accreditation requirements.
- Develops short/long-term objectives and monitors processes and procedures to ensure consistency with the enterprise and compliance with state and federal regulations.
- Collaborates with community partners to resolve issues or find solutions.
- Manages budget and special projects.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Serves in a supportive role as a member of the Physician’s Advisory, Quality Improvement and Utilization Management, Compliance, Fraud, Was
