Utilization Management Director

3 days ago


Los Angeles, California, United States Management Business Solutions Full time
Job Title: Utilization Management Director

Management 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 Responsibilities:
  • Develop and maintain policies and procedures for the Service Area or Medical Center related to Utilization Management.
  • Collaborate with multi-disciplinary teams to plan and coordinate care across the continuum.
  • Coordinate and manage members' care with non-KFH hospital facilities and providers.
  • Identify risk management and quality of care issues across the continuum.
  • Manage transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs.
  • Assure compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
  • Provide direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.
  • Assist in conducting statistical studies in utilization trends, patterns, and outcomes.
  • Hire, train, coach, discipline professional and clerical support staff.
Requirements:
  • Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
  • BSN or bachelor's degree in healthcare-related field such as management, health services administration.
  • Registered Nurse License (California).
Preferred Qualifications:
  • Certified Case Manager.
  • Master's Degree in Management.
  • Management experience in a union environment.
  • Experience in a large hospital, high volume setting.
Benefits:
  • Competitive salary range: $150,000 - $175,000 per year.
  • Benefits package including 401(k), dental insurance, disability insurance, employee assistance program, employee discount, flexible schedule, flexible spending account, free parking, health insurance, health savings account, life insurance, loan repayment program, paid time off, parental leave, professional development assistance, referral program, relocation assistance, retirement plan, travel reimbursement, tuition reimbursement, vision insurance.


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