- 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. Education
- BSN or bachelor's degree in healthcare related field such as management, health services administration. License, Certification, Registration
- Current California RN license.
- 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.
- N/A.
-
Utilization Management Specialist
2 weeks ago
Keck Medical Center of USC Los Angeles, United StatesThe Utilization Management Specialist coordinates communication with admitting financial counselors, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. The Utilization Management S ...
-
Lvn Utilization Manager
1 day ago
Clinica Romero Los Angeles, United States**Position Title**:LVN Utilization Manager · **Department**:Medical · **Position reports to**:Director of Nursing · **Position Summary**: · The LVN Utilization Manager ensures that health care services are administered with quality, cost efficiency, and within compliance. By cont ...
-
Utilization Management Deptartment Lead
2 weeks ago
Radnet Management, Inc. Los Angeles, United StatesOverview: · Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are _Leading Radiology Forward_. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people w ...
-
Pharmacy Utilization Management Rn
2 days ago
Optum Los Angeles, United StatesFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** · If you are located in PST time zone state ...
-
Case Manager Utilization RN-Per Diem
1 day ago
Kaiser Los Angeles, United States Full timeJob Summary: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitaliza ...
-
Case Manager Utilization Rn-per Diem
3 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
-
Case Manager Utilization RN-Per Diem Day
2 weeks ago
Kaiser Los Angeles, United States Full timeJob Summary: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitaliza ...
-
Case Manager Utilization Rn, 40/hr Day
2 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
-
Case Manager Utilization Rn-per Diem Day
2 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
-
Case Manager Utilization Rn, 24/hr Day
2 weeks ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
-
Utility Manager
3 weeks ago
AltaMed Los Angeles, United StatesThe LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines. Responsible for reviewing proposed hospitalization, home care, and inpa ...
-
Utilization Manager
2 weeks ago
APLA Health Los Angeles, United StatesJob Details · Job Location · Baldwin Hills - Offices - Los Angeles, CA · Salary Range · $80, $106,345.36 Salary/year · Description · POSITION SUMMARY: · This position is responsible for the management of the daily operations of Utilization Management (UM) at APLA Health and ...
-
Case Manager Utilization Rn, 40/hr Day
4 days ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
-
Case Manager Utilization Rn, 32/hr Day
1 day ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
-
Manager, Utilization Management
3 weeks ago
Optum Arcadia, United StatesFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** · Position in this function is responsible ...
-
Manager Utilization Management
3 weeks ago
Kaiser Permanente Woodland Hills, United States**Job Summary**: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utili ...
-
Manager Utilization Management
2 weeks ago
Kaiser Permanente Panorama City, United States**Job Summary**: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utili ...
-
Manager Utilization Management
2 weeks ago
Kaiser Permanente Los Angeles, United States Full timeJob Summary: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilizat ...
-
Manager Utilization Management
4 days ago
Kaiser Permanente Los Angeles, United StatesManages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Ca ...
-
Utilization Management Coordinator
2 weeks ago
360 Behavioral Health Van Nuys, United States**Who are we?** · At 360 Behavioral Health, we take pride in our long-standing commitment to providing exceptional care for individuals impacted by autism and other developmental delays. With over three decades of expertise, we are one of the original and most established Applied ...
Manager of Utilization Management, RN - Los Angeles, United States - Kaiser Permanente
Description
Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others as assigned.Essential Responsibilities:
Basic Qualifications:Experience
Additional Requirements:
Preferred Qualifications: