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Utilization Management Supervisor
2 months ago
Location: Los Angeles, CA, US
Compensation: $165,000 - $175,000 + Bonus + SIGNING BONUS + Paid Relocation
*RN Required*
On-Call Rotation Required
The Manager of Utilization Management oversees the daily functions of the Utilization Management Program within the designated Service Area or Medical Center. This role is pivotal in ensuring that patient care is both cost-effective and of high quality through the judicious use of resources. The position involves providing leadership to staff, which may encompass Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation, and other assigned duties.
This role is situated within an acute care hospital environment and is essential in supporting Case Management. The department focuses on facilitating patient transitions to higher levels of care or ensuring efficient discharge processes to guarantee that patients receive necessary home care.
Key Responsibilities:
- Assist in formulating and upholding policies and procedures pertinent to Utilization Management for the Service Area or Medical Center.
- Collaborate with interdisciplinary teams to strategize and coordinate care throughout the continuum.
- Manage and coordinate member care with external hospital facilities and providers, identifying risk management and quality of care challenges.
- Communicate issues and recommendations to relevant interdisciplinary team members.
- Oversee the transportation program to ensure optimal resource utilization that aligns with Health Plan guidelines and patient requirements.
- Ensure adherence to Federal, State, TJC, NCQA, and other regulatory standards and internal policies.
- Guide staff in utilization review, care coordination, discharge planning, and other services across the care continuum.
- Conduct statistical analyses of utilization trends, patterns, and outcomes.
- Recruit, train, mentor, and manage professional and clerical support personnel.
- At least three (3) years of experience in utilization management and discharge planning within an acute care setting, including supervisory or management roles.
- BSN or a bachelor's degree in a healthcare-related field such as management or health services administration.
- Registered Nurse License (California)
- Proven knowledge of healthcare operations and management, including TJC, Title XXII, Medicare, MediCal, and other relevant regulations.
- Understanding of managed care operations.
- Strong interpersonal, negotiation, and management capabilities.
- Effective oral and written communication skills.
- Able to thrive in a Labor/Management Partnership environment.
- Certified Case Manager credential.
- Master's Degree.
- Management experience in a unionized setting.
- Experience in a large, high-volume hospital environment.
Compensation: $150,000 - $175,000 per year
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Free parking
- Health insurance
- Health savings account
- Life insurance
- Loan repayment program
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
- Relocation assistance
- Retirement plan
- Travel reimbursement
- Tuition reimbursement
- Vision insurance
