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Utilization Management Director

1 month ago

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

As a Manager of Utilization Management at Kaiser Permanente, you will play a critical role in ensuring cost-effective and quality patient care by optimizing resource utilization. You will provide strategic direction to staff, collaborating with multidisciplinary teams to plan and coordinate care across the continuum. Your expertise in healthcare management, risk management, and quality of care will be essential in identifying and addressing issues that impact patient outcomes.

Key Responsibilities:
  • Develop and maintain policies and procedures for Utilization Management, ensuring compliance with regulatory agencies and internal standards.
  • Collaborate with multidisciplinary 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 alignment with Kaiser Permanente's mission and values.
  • Conduct statistical studies to analyze utilization trends, patterns, and outcomes, informing strategic decisions.
  • Hire, train, and coach professional and clerical support staff, promoting a culture of excellence and teamwork.
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, and MediCal regulations.
  • Demonstrated interpersonal, negotiation, and management skills, with excellent oral and written communication skills.
About Kaiser Permanente:

Kaiser Permanente is a leader in integrated healthcare, committed to providing high-quality, patient-centered care. As a Manager of Utilization Management, you will be part of a dynamic team dedicated to improving the health and well-being of our members and communities.