22 Director Utilization Management Jobs in San Diego, CA
Kaiser Permanente is Hiring a Director Utilization Management Near San Diego, CA
- Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Service Areas or Medical Centers 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 departments budgets.
- Assures compliance with Federal, State, TJC, 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.
Qualifications:
Basic Qualifications:
Experience
· Minimum three (3) years of experience in directing utilization management and discharge planning in an acute care setting.
Education
· BSN or bachelor's degree in healthcare related field such as management, health services administration.
License, Certification, Registration
· Registered Nurse License (California)
Additional Requirements:
· Demonstrated knowledge of operations and healthcare management; TJC, 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.
· Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
· Master's degree in a related field such as nursing, business or health services administration preferred.
Job Summary
Other
Hospital
$128k-166k (estimate)
10/15/2023
06/13/2024
LOMITA, CA
>50,000
2007
THELMA NERI
$50M - $200M
Hospital
