Utilization Management Director

5 days ago


Los Angeles, California, United States Kaiser Permanente Full time

We are seeking an experienced Clinical Operations Leader to join our team at Kaiser Permanente. This is a leadership role that requires strong management skills, knowledge of healthcare operations, and excellent communication skills.

Job Summary:

This position oversees the Utilization Management programs in a Service Area or Medical Center, ensuring compliance with Federal, State, TJC, NCQA, and internal standards. The ideal candidate will have a minimum of three years of experience in directing utilization management and discharge planning in an acute care setting.

The successful candidate will be responsible for developing and implementing utilization programs to meet the Service Areas or Medical Centers' utilization goals while maintaining customer satisfaction. They will also oversee outside medical services based on Health Plan benefit guidelines and medical necessity.

We offer a competitive salary range of $120,000 - $180,000 per year, depending on experience, plus comprehensive benefits.

Key Responsibilities:
  • Provide overall direction, design, development implementation and monitoring of utilization programs.
  • Act as a resource to the medical staff, administrative staff, divisional, SCPMG, TPMG, and external regulatory agencies.
  • Oversee outside medical services and analyze significant utilization trends, patterns, and impact.
  • Hire, coach, train, and discipline staff to ensure smooth operations in utilization management.
Requirements:
  • Bachelor's degree in a healthcare-related field, such as management or health services administration.
  • Registered Nurse License (California).
  • Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, Medi-Cal, and other local, state, and federal regulations.
About Us:

Kaiser Permanente is a leading healthcare provider dedicated to delivering high-quality patient care and improving the health of our communities. Our organization is committed to innovation, diversity, and inclusion.



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