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Consulting Services & Project/Program Management (Non-IT)

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UM/Case Mngt RN, Practice Specialist

Location: Pasadena, CA Additional Locations:
Job Number: 696235 Date posted: 04/27/2018
Recognized content expert in area relevant to the work of the department. Oversees project work and staff on work related to area of expertise. Responsible for providing relevant content expertise to project leads and staff in support of project work. Builds and maintains key relationships with clients and departmental staff as appropriate. Acts as thought partner to project managers and provides expert advice on specific area of expertise. Provides leadership for the delivery high of quality and cost-effective consulting services/products to issues of key organizational importance.

Essential Functions:
- Effectively leads project team on work related to specific area of expertise.
- Provides leadership for the design, development, and implementation of projects related to their area of expertise.
- Manages the work of all project participants, including outside consultants and other department staff, when used.
- Serves as a content expert for responsible area of expertise.
- Provides assistance and advice to others in support of project work.
- May provide expert consultation to multiple projects at any given time.
- Effectively interfaces with clients to reach mutually acceptable agreements around project scope, objectives, deliverables, timeframes and outcomes.
- Effectively facilitates interactions with clients and stakeholders to achieve desired outcomes.
- Provides leadership and direction in accordance with the overall strategic direction of the department and organization.
- Develops clear project plan that allows teams to achieve desired outcomes.
- Monitors plan on an ongoing basis and proactively adjusts, as necessary, to resolve barriers and/or issues.
- Oversees work to ensure high quality deliverables and adherence to timeframes and budget (when applicable).
- Proactively identifies links between specialty work and broader organizational priorities and goals.
- Identifies areas where specialty expertise may enhance work of department.
- Effectively recognizes opportunities to enhance project work and/or achieve desired objectives by collaborating with staff outside their area of expertise and acts accordingly.
- Contributes to a team environment that encourages collaboration, supports receiving and providing feedback and encourages participation from all levels of staff.
- Adapts management style as appropriate to meet needs of a particular situation or team resulting in optimal performance.
- Actively provides feedback to staff in support of individual staff development.
- Encourages staff participation in non-project related activities that support culture and values of the department and individual development.
- Models behavior that staff wants to emulate.
- Communicates in a manner that is proactive, timely, influential, persuasive and effective resulting in mutually acceptable agreements.
- Ensures that all communications produced under his/her direction are timely and of high quality.
- Participates in the development and management of department staff through coaching, providing and encouraging feedback, consistent application of department policies and procedures, conducting project based performance reviews, and other departmental activities.
- Participates in development of staff through the sharing of new techniques and problem solving approaches specific to their area of expertise.
- Participates in the development and implementation of department-wide activities that support the culture and values of the department.

This is a Repost of 542370.

Basic Qualifications:
- N/A.
- Bachelor's degree.
License, Certification, Registration
- N/A
Additional Requirements:
- Demonstrated expertise in a field of relevant to the work of the department.
- Demonstrated ability to determine the key business issues and develop appropriate action plans from multi-disciplinary perspectives.
- Demonstrated ability to lead professionals through influence and collaboration.
- Knowledge of computer applications and knowledge of data systems.
- Proven leadership skills in a matrix management environment that includes influencing, efficiency, collaboration, candor, and openness with a focus on results orientation.
- Experience in managing project staff including administration of departmental policies and guidelines, project based performance reviews and coaching.
- Demonstrates ability to work with various partners including Medical Group and/or Labor Partners.
- Demonstrated understanding and general knowledge of healthcare industry and health policy trends.
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
- Minimum five (5) years of experience in their field of expertise preferred. This may include but is not limited knowledge of care delivery, technical/analytic expertise, management engineering, planning, and research.
- Master's degree or six (6) years of experience in a directly related field required in business administration, economics, operations research, public health, health administration or other related field preferred.

- Knowledge of the operations and/or business of Kaiser Permanente preferred.

- Oversees adherence to quality of care and utilization standards by reviewing documentation and analysis of utilization data.
- Develops standards of care and quality improvement activities based on regulatory standards.
- Serves as a resource to senior management as UM and CM experts.
- Develops regional programs based on regulatory requirements.
- Collaborates with program re-design to meet targeted utilization outcomes.
- Provides clinical and regulatory expertise for contractual reviews and for regional regulatory surveys.
- Provides oversight to design, develop, implement and monitor UM and Case Management programs to meet regional utilization goals while maintaining customer satisfaction.
- Acts as a resource to Directors, Assistant Administrators, Ambulatory Medical Staff, SCPMG and external regulatory agencies for all issues relating to UM.
- Analyzes and reports significant utilization trends, patterns and impact to appropriate departments.
- Serves as a contract liaison for regional issues pertaining to contracts and vendor, outside medical and transportation.
- Provides education and training to UM Directors, Physicians and Case Managers to ensure smooth operations in UM and CM.
- Makes significant contributions and or provides clinical and technical leadership to high visibility projects to identify and resolve issues of strategic importance to the organization.
- Interfaces regularly with senior management to produce timely and valuable results.
- Sets the strategic direction of projects.
- Determines goals and priorities with management team sponsor.
- Establishes team membership and negotiates time commitments and resources.
- Develops proposals for clients outlining proposed project structure, approach and work plan.
- Provides staff leadership to project teams, as well as manages work of outside consultants when needed.
- Designs research plans for data gathering and analysis; participates significantly in interpreting analysis and developing action plans accordingly.
- Produces or oversees development of written materials for senior executives and other key clients.


Developing, managing and providing the Utilization Management programs in a service area or 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.

Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Consulting Services / Project/Program Management (Non IT) Department: Regional Utilization Management Travel: Yes, 20 % of the Time

About Consulting Services & Project/program Management (non-it) Careers

Consulting Services & Project/program Management (non-it) Careers

These careers consist of Program and Project Managers, Business Consultants, Business Analysts, and Data Analysts who all work together to effect positive organizational change from the inside out.

Join our talented team and make a difference through performing business analysis, developing business cases, providing client support during system development and implementation, managing projects, or by leading complex programs with multiple work streams.

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