- 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.
- N/A.
- Rotating On-Call Weekends
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Utilization Manager
2 days 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 ...
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Utility Account Manager
2 weeks ago
Insight Global Los Angeles, United StatesTitle: Gas & Electric Utility Client Account Manager · Location: Los Angeles, CA or San Diego, CA (Hybrid) · Salary: $150-$200K · Qualifications: · Bachelor of Science, Engineering, or related technical field. · Minimum 8+ years of related experience, including 4-5 years of direc ...
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LVN Utilization Manager
2 weeks ago
Clinica Romero Los Angeles, United StatesJob Description · Job DescriptionSalary: · 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 efficienc ...
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Utilization Management Nurse, Senior
6 days ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Facility Compliance Review team Review post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events.. The Utilization Management Nurse, Senior will report to the Senio ...
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Utilization Management Nurse, Senior
2 weeks ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will ...
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Utilization Management Supervisor
1 week ago
University of California Los Angeles, United StatesTake on an important leadership role within an award-winning health system. Help improve patient experiences and operational efficiency as part of a world-class healthcare team. Take your career in an exciting new direction. You can do all this and more at UCLA Health. · As a key ...
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Senior Utilization Management Assistant
3 weeks ago
Providence Los Angeles, United States Full timeUnder the supervision of Regional Director of Care Management, the Utilization Management Coordinator is responsible for providing support to the Care Management team who coordinates care. This position works closely as a healthcare team member and performs complex tasks related ...
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Utilization Management Nurse, Senior
3 weeks ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Commercial Post Service Review team is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. The Commercial Post Service Review RN will report to the Manager, Post Service. In this role you will perform accurate a ...
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Utilization Management Supervisor
2 days ago
UCLA Health Los Angeles, United StatesTake on an important leadership role within an award-winning health system. Help improve patient experiences and operational efficiency as part of a world-class healthcare team. Take your career in an exciting new direction. You can do all this and m Management, Supervisor, Healt ...
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RN Case Manager/Utilization Review
5 days ago
Keck Medicine of USC Los Angeles, United States Full time· The RN Float Case Manager and Utilization Review Nurse provides coverage for an RN Case Manager or RN Utilization Review Nurse. The RN Float Case Manager and Utilization Review Nurse is assigned to function in the role of either a RN Case Manager or RN Utilization Review Nurse ...
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Manager Utilization Management
2 weeks 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 ...
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RN Supervisor, Utilization Management
3 weeks ago
North American Staffing Group Los Angeles, United StatesJob Description · Job DescriptionMedica Talent Group is excited to share this Direct Hire opportunity with you · We are looking foran experienced RN Supervisor, Utilization Management seeking a permanent opportunity. Our client offers growth and an exciting workplace to join alon ...
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Supervisor, Utilization Management RN
1 week ago
L.A. Care Health Plan Los Angeles, United StatesPress Tab to Move to Skip to Content Link · Select how often (in days) to receive an alert: · Job Category: · Clinical · Location: · Los Angeles, CA, US, 90017 · Position Type: · Full Time · Requisition ID: · 10949 · Salary Range: · $102, Min.) - $132, Mid.) - $163, Max.) · ...
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Supervisor, Utilization Management RN
1 week ago
North American Staffing Group, Inc. Los Angeles, United StatesJob Description · Job DescriptionTitle: Supervisor, UM RN · Term: Direct-Hire, full time · Location: Fully Remote (Company located in Los Angeles, CA.) · Requirements: · Bachelor's degree in nursing. · Active License · CCM Certification · Advanced Certification in Excel software ...
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Utilization Management Denial Coordinator
5 days ago
University of California Los Angeles, United StatesTake on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. · In this key position, you will be the primary point of contact fo ...
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Utilization Management Denial Coordinator
4 days ago
UCLA Health Los Angeles, United StatesTake on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. · In this key position, you will be the primary point of contact f ...
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Utilization Management Denial Coordinator
3 days ago
University of California Los Angeles, United StatesTake on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. · In this key position, you will be the primary point of contact f ...
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UCLA Health Los Angeles, United StatesProvide key clinical support within a world-class health organization. Help ensure the delivery of exceptional, compassionate, and appropriate patient care. Take your professional expertise to the next level. You can do all this and more at UCLA Health. · Under the direction and ...
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UCLA Health Los Angeles, United StatesGeneral InformationPress space or enter keys to toggle section visibilityWork Location: Los Angeles, USAOnsite or RemoteFlexible HybridWork ScheduleWednesday - Friday 1:00pm - 10:00PM PST, Saturday - Sunday 8:00am - 5:00pm PSTPosted Date04/09/2024Salary Range: $ HourlyEmployment ...
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360 Behavioral Health Los Angeles, United StatesUtilization Management Coordinator- Temporary Assignment · Job Category · : · Z&S Management Chatsworth Support Center · Requisition Number · : · UTILI002753 · Apply now · Posted : April 23, 2024 · Full-Time · Locations · Showing 1 location · Van Nuys, CA 91406, USA · Desc ...
Manager Utilization Management - Los Angeles, United States - Kaiser Permanente
Description
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 Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and others as assigned.
Essential Responsibilities:
Experience
Notes:
