Director Utilization Management
Primary Location Moreno Valley, California
Facility Moreno Valley Medical Center
Job Number 1242615 Date posted 04/24/2024
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Description:
Develops, manages and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization Review program, Transportation coordination and Extended Care Coordination to promote a centralized, coordinated, interdisciplinary process in the continuum of care.
Job Summary:
Develops, manages and directs the Utilization Management programs in a Service Area or a Medical Center. Develops and manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization Review program, Transportation coordination and Extended Care Coordination to promote a centralized, coordinated, interdisciplinary process in the continuum of care.
Essential Responsibilities:
- Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Service Areas or Medical Centers utilization goals while maintaining customer satisfaction.
- Acts as a resource to the medical staff, administrative staff, divisional, SCPMG, TPMG and external regulatory agencies in all issues relating to utilization management within the Service Area or Medical Center.
- Oversees outside medical services based on Health Plan benefit guidelines and medical necessity.
- Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
- May direct the operations of outside referrals/transportation services.
- May serve as contract liaison for the Service Area or Medical Center on issues pertaining to new or existing contracts with outside vendors.
- Develops, monitors and controls departments budgets.
- Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and  requirements.
- Hires, coaches, trains and disciplines staff to ensure smooth operations in utilization management.
- Also facilitates educational training for medical staff on issues related to utilization management.
Basic Qualifications:
Experience
- Minimum three (3) years of experience in directing utilization management and discharge planning in an acute care setting.
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, 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.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Masters degree in a related field such as nursing, business or health services administration preferred.
Notes:
- Director of Utilization Management for Moreno Valley Hospital, South Riverside County and Coachella Valley affiliate hospitals
Primary Location: California,Moreno Valley,Moreno Valley Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Director/Senior Director
Department: Moreno Valley Hospital - Utilization Management - 0801
Pay Range: $148800 - $192500 / 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
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
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
