Manager Utilization Management
Primary Location Modesto, California
Worker Location Onsite
Facility Modesto Medical Center
Job Number 1320645 Date posted 11/13/2024
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Description:
Develops, coordinates and manages the administrative and operational activities that are directly associated with the utilization management of medical services provided to Kaiser members. Works independently; establishes priorities for staff.
Job Summary:
Develops, coordinates and manages the administrative and operational activities that are directly associated with the utilization management of medical services provided to Kaiser members. Works independently; establishes priorities for staff.
Essential Responsibilities:
- Chairs and Co-chairs local committees focused on creating, implementing and monitoring work plans to achieve UM targets and performance improvement. Provides expertise into target setting processes. Shares accountability with other medical center leadership for the daily monitoring of utilization indicators and performance, identification and escalation of problems, and initiation and evaluation of action plans for achieving medical center targets and improve the quality of care and services. Participates and provides UM expertise on local and regional committees, including UM Peer, UM Chiefs/Directors, Quality, TPMG, other departments and contracted/planned providers. Manages projects related to chart reviews.
- Conducts utilization data analysis (avoidable days, readmissions, UMAB, PRS reports, one-day stays, DRGs, LOS, PDRs, etc.) for trending and development of performance improvement initiatives. Partners with the UM Chief and KFH/TPMG local medical center leadership, to engage the following areas in the development and implementation of a comprehensive utilization management work plan to meet or exceed medical center targets: Physicians, managers across the continuum, and TPMG/KFH service leaders and managers. May include oversight of the coordination of KP members care with leaders responsible for UM activities associated with alliance/contract hospitals and networks.
- Links with the Quality Department to ensure quality improvement, risk, and safety management activities are aligned with local UM initiatives.
- Identifies and incorporates (as appropriate) evidence-based best/successful practices (e.g. care paths, innovative discharge planning/case management models, etc.) into efforts to improve quality of care/service and reduce costs.
- Collaborates with interdisciplinary teams across the continuum of care including, but not limited to (HBS, TPMG Sub-specialty departments, Nursing, MSW, PT/OT, HH, Hospice, SNF, CCM, Behavioral Health, Rehabilitation, etc.). to ensure patient care is effectively provided, clinically appropriate, service oriented, safe and cost effective. Partners with TPMG to provide UM related education and training as needed.
- Ensures compliance with regulatory/accreditation (NCQA, MDQR, CMS, Medi-Cal, DMHC, DOL, JCAHO,etc.) requirements related to UM by partnering with other departments and facilitating workgroups in maintaining survey readiness.
- HR related activities (average 18 employees): Manages and resolves human resource, employee, department safety, and risk management issues. Responsible for all aspects of staff management including, hiring, development/training, performance reviews and terminations.
- Manages department budget and finances. Develops implements, and monitors departmental policies and procedures.
- Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications:
Experience
- Three (3) or more years of experience in management /leadership in a hospital or outpatient setting.
- Minimum three (3) years of previous experience in utilization management activities required.
Education
- Graduate of accredited school of nursing.
- BSN or BA in health care related field or 4 years of equivalent experience required.
License, Certification, Registration
- Registered Nurse License (California)
Additional Requirements:
- Knowledge of the Nurse Practice Act, JCAHO, NCQA, and other local, state, and federal regulations.
- Demonstrated skills in leading and facilitating the efforts of multidisciplinary groups.
- Demonstrated strong communication, problem-solving and analytical skills.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Masters degree preferred.
Primary Location: California,Modesto,Modesto Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Wk1: Mon, Tue, Wed, Thu, Fri; Wk2: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: Modesto Hospital - UR-Discharge Planning - 0201
Pay Range: $168100 - $217470 / year
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: Yes, 25 % of the Time
On-site: Work location is on-site (KP designated office, medical office building or hospital).
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
