Director of Utilization Management
3 days ago
As a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.
Key Responsibilities- Provide overall direction, design, development, implementation, and monitoring of utilization programs to meet the organization's utilization goals while maintaining customer satisfaction.
- Act as a resource to the medical staff, administrative staff, and external regulatory agencies in all issues relating to utilization management.
- Oversee outside medical services based on Health Plan benefit guidelines and medical necessity.
- Analyze and report significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
- Direct the operations of outside referrals/transportation services.
- Develop, monitor, and control departmental budgets.
- Assure compliance with Federal, State, TJC, NCQA, and other regulatory agencies and internal standards and requirements.
- Hire, coach, train, and discipline staff to ensure smooth operations in utilization management.
- Facilitate educational training for medical staff on issues related to utilization management.
- Minimum three (3) years of experience in directing utilization management and discharge planning in an acute care setting.
- 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; TJC, Title XXII, Medicare, Medi-Cal, and other local, state, and federal regulations.
- Knowledge of managed care operations.
- Demonstrated interpersonal, negotiation, and leadership skills.
- Effective oral and written communication skills.
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Utilization Management Director
3 days ago
Los Angeles, California, United States Management Business Solutions Full timeJob Title: Utilization Management DirectorManagement Business Solutions is seeking a highly skilled Utilization Management Director to join our team. As a key member of our healthcare operations team, you will be responsible for managing the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center.Key...
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Utilization Management Program Director
2 weeks ago
Los Angeles, California, United States Management Business Solutions Full timeJob Title: Utilization Management Program DirectorManagement Business Solutions is seeking a highly skilled Utilization Management Program Director to lead our team in providing exceptional patient care and ensuring cost-effective utilization of resources.Key Responsibilities:Develop and maintain policies and procedures for Utilization ManagementCollaborate...
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Director of Utilization Management
3 weeks ago
Los Angeles, California, United States healthcarerecruitmentpartners Full timeDirector of Utilization ManagementThe Director of Utilization Management plays a pivotal role in overseeing the Case Management and Utilization Review program. This individual is responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions such as Discharge...
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Utilization Management Director
10 hours ago
Los Angeles, California, United States APLA Health Full timeJob SummaryWe are seeking a highly skilled Utilization Management Director to join our team at APLA Health. As a key member of our healthcare operations team, you will be responsible for managing the daily operations of Utilization Management (UM) at APLA Health and Wellness (APLAHW).Key ResponsibilitiesDevelop and implement a standardized Utilization...
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Outpatient Utilization Manager
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob SummaryWe are seeking a highly skilled Outpatient UM Clinician to join our team at MedPOINT Management. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesReview and process precertification requests for medical necessity,...
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Director of Utilization Management
2 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryAs a key member of our team, the Director of Utilization Management will be responsible for developing and managing programs that emphasize appropriate admissions, concurrent and retrospective review of care, and other integrated functions to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Key...
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Utilization Management Program Director
3 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:As a key member of the Kaiser Permanente team, the Utilization Management Program Director plays a vital role in ensuring cost-effective and quality patient care. This position oversees the day-to-day operations of the Utilization Management Program, collaborating with multidisciplinary teams to plan and coordinate care across the continuum. The...
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Los Angeles, California, United States Healthcare Recruitment Partners Full timeJob SummaryHealthcare Recruitment Partners is seeking a highly skilled Director of Utilization Management and Case Coordination to lead our team in Los Angeles, California. As a key member of our organization, you will be responsible for directing the Case Management and Utilization Review program, developing and managing programs that emphasize appropriate...
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Utilization Management Program Director
4 weeks ago
Los Angeles, California, United States Recruitics JB Full timeJob Summary:As a key member of the Recruitics JB team, we are seeking a skilled Utilization Management Program Director to lead our 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 ideal candidate will provide...
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Los Angeles, California, United States Blue Shield of CA Full timeYour RoleAs a key member of the Utilization Management team at Blue Shield of California, you will play a critical role in delivering and collaborating on all aspects of utilization management and care coordination for Commercial membership.This position requires a strong leader who can provide direction and leadership in compliance to regulatory...
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Utilization Management Program Director
2 days ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary: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...
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Utilization Management Nurse Senior
2 weeks ago
Los Angeles, California, United States Blue Shield of CA Full timeJob Title: Utilization Management Nurse, SeniorAbout the Role:The Utilization Management Nurse, Senior will play a critical role in ensuring that our members receive the most appropriate care possible. As a member of the Utilization Management team, you will be responsible for reviewing inpatient stays to determine medical necessity and ensuring that our...
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Utilization Management Nurse Senior
4 weeks ago
Los Angeles, California, United States Blue Shield of CA Full timeJob SummaryWe are seeking a highly skilled Utilization Management Nurse, Senior to join our team at Blue Shield of CA. As a key member of our Utilization Management team, you will play a critical role in reviewing inpatient stays for our members and ensuring that nationally recognized levels of care are applied correctly.Key ResponsibilitiesPerform...
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Utilization Management Nurse Senior
4 weeks ago
Los Angeles, California, United States Blue Shield of CA Full timeJob SummaryWe are seeking a highly skilled Utilization Management Nurse, Senior to join our team at Blue Shield of CA. As a key member of our Utilization Management team, you will play a critical role in reviewing inpatient stays for our members and ensuring that nationally recognized levels of care are applied correctly.Key ResponsibilitiesPerform...
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Director of Utilization Management
1 week ago
Los Angeles, California, United States Kaiser Permanente Full timeJob SummaryDevelops, manages, and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions, concurrent, and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization...
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Healthcare Manager
3 days ago
Los Angeles, California, United States Management Business Solutions Full timeJob SummaryManagement Business Solutions is seeking a skilled Healthcare Manager to lead our Utilization Management Program. As a key member of our team, you will be responsible for managing the day-to-day operations of the program, ensuring cost-effective and quality patient care through appropriate resource utilization.Key Responsibilities:Develop and...
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Utilization Management Specialist
3 weeks ago
Los Angeles, California, United States APLA Health Full timeJob SummaryThis is a challenging and rewarding role that requires a strong background in healthcare operations and management. As a Utilization Manager at APLA Health, you will be responsible for overseeing the daily operations of our Utilization Management (UM) program, ensuring that all processes and programs are fully implemented and compliant with...
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Utilization Management RN
1 month ago
Los Angeles, California, United States Family Health Centers of San Diego Full timeJob SummaryFamily Health Centers of San Diego is seeking a skilled Utilization Management RN to join our team. As a Utilization Management RN, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary costs.Key ResponsibilitiesConduct prospective, initial, and retrospective reviews of inpatient,...
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RN Manager of Utilization Management
3 weeks ago
Los Angeles, California, United States healthcarerecruitmentpartners Full timeRN Manager of Utilization Management Job SummaryThe RN Manager of Utilization Management is a key role in our healthcare organization, responsible for overseeing the coordination of services through an interdisciplinary process. This position requires a strong leader who can balance individually identified patient and family needs with cost-effective...
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RN Manager of Utilization Management
1 week ago
Los Angeles, California, United States healthcarerecruitmentpartners Full timeRN Manager of Utilization Management Job SummaryWe are seeking a skilled RN Manager of Utilization Management to oversee the coordination of services through an interdisciplinary process. The ideal candidate will have a strong background in case management and be able to assess patients to determine the appropriate level of care.Key...