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Nurse Manager, Inpatient Utilization Management Health Plan

Location Portland, Oregon Job Number 979937 Date posted 10/14/2021
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Description:
Manages and directs the inpatient Utilization Management (UM) department for Kaiser Permanente Northwest (KPNW), including day-to-day operations.  Ensures cost effective and quality patient care by appropriate utilization of resources. Manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care including monitoring and compliance activities, consultation and clinical case reviews of UM coverage decisions and notification. Ensures compliance with federal and state laws, regulations and accreditation standards and Kaiser Permanente policies for all Regional services and processes that fall within the scope of inpatient UM. Collaborates with Hospital Administration Practice Director, Director of RTMC and VH, and other key stakeholders in the development and maintenance of policies and procedures related to inpatient UM.




Essential Responsibilities:



  • 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.


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 (Washington) required at hire




  • Registered Nurse License (Oregon) required at hire

     



Additional Requirements:



  • 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.

     



Preferred Qualifications:



  • 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.


Primary Location: Oregon,Portland,Kaiser Permanente Building 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 Employee Status: Regular Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee Job Level: Manager with Direct Reports Department: Kaiser Permanente Building - Utilization Mgmt-Admin - 1008 Travel: Yes, 25 % of the Time 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.

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.