Kaiser Permanente is looking for a Mgr Utilization Mgmt
Qualifications: Current California RN license. BSN or BA or BS degree in healthcare related field such as management, health services administration. At least three (3) to five (5) years experience in utilization management and discharge planning in an acute care setting to also include previous supervisory or management experience. Demonstrated knowledge of operations and healthcare management; JCAHO, 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.Duties: Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management. Collaborates with the multi disciplinary team´s 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, JCAHO, 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. 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.In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.Kaiser Permanente is an EEO/AA Employer.Notes: Schedule varies.