Director of Utilization Management

Health care is changing. Kaiser Permanente leads the way. More than eight million people rely on us for their healthcare. Join our outstanding team and make a difference...every day. Our quality of care is unmatched and so are our health care careers. Employment opportunities are available throughout our California Region, made up of 28 acute care hospitals, including two specialty tertiary centers and 120 ambulatory care centers. Our 85,000 employees and more than 7,000 physicians provide the highest quality of care to over 6 million members. Come join our award winning team and enhance your skills in a full time, part time or per diem position.Qualifications: Current California RN license. BSN or BA or BS degree in healthcare related field such as management, health services administration. Relevant Masters degree in a related field such as nursing, business or health services administration preferred. Three (3) to five (5)+ years experience in directing utilization management and discharge planning in an acute care setting. Demonstrated knowledge of operations and healthcare management; JCAHO, 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. Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to customers, contracted providers, and vendors. Preferred Qualifications: Computer literate with PC, Laptop, MS Suite and Lotus Notes. Duties: Develops, manages & directs Utilization Management Programs in a Service Area and Medical Centers.  Develops and manages programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. 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. Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Service Area's or Medical Center's 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 department's budgets. Assures compliance with Federal, State, JCAHO, 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. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures. Notes: Able to adjust schedule to departmental need. This position will cover Anaheim and Irvine, ability to travel throughtout Orange County as needed. We are an EEO/AA/M/F/D/V Employer. Additional Information Reference Code: 1033782 Position Type: Full Time