Utilization Management Program Director
2 days ago
As a key member of the Kaiser Permanente team, the Utilization Management Program Director will oversee the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. This role is responsible for ensuring cost-effective and quality patient care by appropriate utilization of resources. The successful candidate will provide direction to staff, which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and others as assigned.
Essential 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 member care with non-KFH hospital facilities and providers, identifying risk management and quality of care issues across the continuum.
- Surface issues and suggestions to the appropriate multi-disciplinary team members.
- Manage the transportation program to ensure appropriate utilization of resources that meet Health Plan guidelines and patient needs.
- Ensure compliance with Federal, State, TJC, NCQA, and 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.
- Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting, including 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).
- 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.
- Rotating On-Call Weekends.
Primary Location: California, Los Angeles, Los Angeles Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: Sunset Medical Center - Utilization Management
Pay Range: $180,620/year
Travel: No
On-site: Work location is on-site (KP designated office, medical office building, or hospital).
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion, and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do.
We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work.
Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce.
Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
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