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Utilization Management Program Director
2 months ago
Kaiser Permanente seeks a skilled Utilization Management Program Director to oversee the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. The ideal candidate will ensure cost-effective and quality patient care by appropriate utilization of resources, providing direction to staff, and collaborating with multi-disciplinary teams to plan and coordinate care across the continuum.
Key Responsibilities:- Develop and Maintain Policies and Procedures: Assist in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management, ensuring compliance with Federal, State, TJC, NCQA, and internal standards and requirements.
- Collaborate with Multi-Disciplinary Teams: Collaborate with the multi-disciplinary teams to plan and coordinate care across the continuum, identifying risk management and quality of care issues.
- Manage Member Care: Coordinate and manage members' care with non-KFH hospital facilities and providers, ensuring appropriate utilization of resources that meet Health Plan guidelines and patient needs.
- Transportation Program Management: Manage the transportation program to ensure appropriate utilization of resources that meet Health Plan guidelines and patient needs.
- Compliance and Quality Assurance: Ensure compliance with Federal, State, TJC, NCQA, and internal standards and requirements, and provide direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.
- Statistical Analysis: Assist in conducting statistical studies in utilization trends, patterns, and outcomes.
- Staff Management: Hires, trains, coaches, disciplines professional and clerical support staff.
- Experience: Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting, including supervisory or management experience.
- Education: BSN or bachelor's degree in a healthcare-related field, such as management or health services administration.
- License, Certification, Registration: Registered Nurse License (California).
- Knowledge and Skills: Demonstrated knowledge of operations and healthcare management, TJC, Title XXII, Medicare, MediCal, and other local, state, and federal regulations. Knowledge of managed care operations, interpersonal, negotiation, and management skills, good oral and written communication skills, and ability to work in a Labor/Management Partnership environment.
