Utilization Management Program Director

5 days ago


Riverside, California, United States Kaiser Permanente Full time
Job Summary:
As a key member of the Kaiser Permanente team, the Utilization Management Program Director plays a critical role in ensuring cost-effective and quality patient care. This position is responsible for managing the day-to-day operations of the Utilization Management Program, collaborating with multidisciplinary teams to plan and coordinate care across the continuum, and identifying risk management and quality of care issues.
Essential Responsibilities:
  • Develop and maintain policies and procedures for Utilization Management, ensuring compliance with Federal, State, TJC, NCQA, and internal standards.
  • Collaborate with healthcare teams to plan and coordinate care, including transportation and discharge planning.
  • Manage transportation programs to ensure appropriate utilization of resources, meeting Health Plan guidelines and patient needs.
  • Provide direction to staff on utilization review, care coordination, and discharge planning.
  • Conduct statistical studies on utilization trends, patterns, and outcomes.
  • Hire, train, and coach 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, including supervisory or management experience.
Education
  • BSN or bachelor's degree in a healthcare-related field, such as management or health services administration.
License, Certification, Registration
  • Registered Nurse License (California).
Additional Requirements:
  • Demonstrated knowledge of operations and healthcare management, including 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.
  • Ability to work in a Labor/Management Partnership environment.
Preferred Qualifications:
  • N/A.


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