Description: Job Summary:

Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others as assigned.

Essential Responsibilities:

• Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management.


• Collaborates with the multi-disciplinary teams to plan and coordinate care across the continuum.


• Coordinates and manages members care with non-KFH hospital facilities and providers. Identifies risk management and quality of care issues across the continuum.


• Surfaces issues and any suggestions to the appropriate multi-disciplinary team members.


• Manages transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs.


• Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.


• Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.


• Assists in conducting statistical studies in utilization trends, patterns, and outcomes.


• Hires, trains coaches, disciplines professional and clerical support staff.

Basic Qualifications:

Experience

• Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.

Education

• BSN or bachelors degree in healthcare related field such as management, health services administration.

License, Certification, Registration

• Registered Nurse License (California)

Additional Requirements:

• Demonstrated knowledge of operations and healthcare management; 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.


• Must be able to work in a Labor/Management Partnership environment.

Notes:

• 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 - 0801
Pay Range: $139600 - $180620 / year The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
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. Submit Interest

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