Nurse Manager, Inpatient Utilization Management Health Plan
Navigating the Hiring Process
We're here to support you!
Having trouble with your account or have questions on the hiring process?
Please visit the FAQ page on our website for assistance.
Need help with your computer and browser settings?
Do you need a reasonable accommodation due to a disability?
A reasonable accommodation is any modification or adjustment that enables you to fully participate in completing the following:
- Online Submissions
- Pre-Hire Assessments
- Interview Process
Please submit your accommodation request and an HR Representative will contact you.
- Develops and maintains policies and procedures related to inpatient Utilization Management for KPNW.
- Collaborates with the multi-disciplinary teams across KPNW for activities related to inpatient Utilization Management. Surfaces issues and any suggestions to the appropriate multi-disciplinary team members.
- Facilitates utilization management for members care with non-KFH hospital facilities and providers. Identifies and reports risk management and quality of care issues.
- Assures compliance with Federal, State, NCQA, other regulatory agencies and internal standards and requirements; including participation in audit activities as needed.
- Provides direction to staff regarding utilization review for inpatient care.
- Assists in conducting statistical studies in utilization trends, patterns, and outcomes.
- Annually researches, reviews, and develops Regional inpatient UM policies, procedures, and criteria based on current federal and state regulatory requirements and organizational needs.
- Hires, trains, coaches, disciplines, and terminates assigned professional and clerical support staff.
- Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff.
- Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
- BSN or bachelors degree in healthcare related field such as management, health services administration.
- Registered Nurse License (Washington) required at hire
- Registered Nurse License (Oregon) required at hire
- Demonstrated knowledge of operations and healthcare management as well as other local, state and federal regulations.
- Knowledge of managed care operations.
- Demonstrated interpersonal, negotiation, and management skills.
- Good oral and written communication skills.
- Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting.
- Minimum five (5) years of supervisory or management experience.
- MSN or masters degree in healthcare related field such as management, health services administration.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.