Healthcare Operations Manager

2 weeks ago


San Diego, California, United States Kaiser Permanente Full time
Job Summary:

As a key member of the Kaiser Permanente team, the Utilization Management Manager 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.

Key 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 discharge planning, transportation, and other services.
  • 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 other services, ensuring high-quality patient care.
  • Conduct statistical studies on utilization trends, patterns, and outcomes, informing program improvements.
  • Recruit, train, and develop professional and clerical support staff, fostering a culture of excellence.
Requirements:
  • Minimum three years of experience in utilization management and discharge planning in an acute care setting, with supervisory or management experience.
  • BSN or bachelor's degree in a healthcare-related field, such as management or health services administration.
  • Registered Nurse License (California) and knowledge of operations and healthcare management, including TJC, Title XXII, Medicare, MediCal, and other local, state, and federal regulations.
  • Demonstrated interpersonal, negotiation, and management skills, with good oral and written communication skills.
Additional Notes:

This role requires rotating on-call duties, including weekends and holidays.



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