Manager Utilization Management
- 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.
- 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 (California)
- 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.
- This is an Exempt position
Recommended Jobs
General Application
We are always looking for top talent although Mitra Chem is currently not hiring . If you come from a lithium-ion battery company or research project, we will review your application and get back to…
Speech Language Pathologist (SLP) - Up to $6,000 Sign-On Bonus
Speech Language Pathologist (SLP) We're seeking a Speech-Language Pathologist (SLP) who is committed to helping children overcome barriers, achieve milestones, and flourish. This is an opportunity to …
Senior Research Associate / Scientist - Immunology and Inflammation
Location San Diego, CA Employment Type Full time Department R&D Genesis Therapeutics is a leader in AI guided rational drug design with the goal to address unmet medical needs in va…
Electrical Technician
ASR Group is the world’s largest refiner and marketer of cane sugar, with an annual production capacity of more than 6 million tons of sugar. The company produces a full line of grocery, industrial, …
Principal Geotechnical Engineer (California GE)
Job Description Job Description GeoSoils, Inc. (GSI), a division of NEC Group Inc., is a geotechnical, coastal, and environmental engineering firm founded in 1974, is seeking Licensed Geotechnica…
Senior Administrative Assistant (Multiple Openings)
Senior Administrative Assistant (Multiple Openings) Location Stanford, CA : Company Description Jobs for Humanity is partnering with Stanford University to build an inclusive and just employment ecos…
Preschool teacher/Infant Teacher
Job Description Job Description Active Finger prints, minimum 12 ECE units required , Including Infant /Toddler class, 1 year experience , CPR ,immunizations TB test ,MMR, whooping cough . Duties…
In-House Marketing Manager
We Put the World on Vacation Travel + Leisure Co. is the world’s leading vacation ownership and travel membership company, with a dynamic and growing portfolio of resort, travel club, and lifestyl…