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Job Summary:The Supervisor Utilization Management will assure compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements and will provide oversight and direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care to ensure patient care quality. The Supervisor will also assist in conducting statistical studies in utilization trends, patterns, and outcomes to ensure compliance with all regulatory standards.Essential Responsibilities:
Provides direction and supervision to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.
Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management.
Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
Provides coaching to the staff regarding performance and attendance issues and assists in performance evaluations.
Surfaces issues and make any suggestions to the appropriate multi-disciplinary team members.
Trains and educates the staff on policies and procedures within the UM department.
Attends various meetings related to the UM department.
Assists in managing various UM related projects and maintain statistical data related to the projects and assists in Quality improvement projects.
Assists in the management of the attendance program and provide coaching, scheduling and maintains vacation modules.
Assists in conflict resolution and corrective actions.
Assists in conducting statistical studies in utilization trends, patterns, and outcomes.
Tracks and manages the use of overtime within the department and will coach staff related to high utilization of overtime.
Indirectly manages the budget by reviewing the utilization of FTEs, overtime, and non-payroll usage.
May be required to cover weekend supervision.
Performs Competency evaluations.
Assumes other activities and responsibilities as needed.
Basic Qualifications:
Experience
Minimum one (1) year of experience in utilization management and/or discharge planning in an acute care setting.
Minimum one (1) year leadership experience in utilization management or healthcare related field.
Education
BSN OR bachelors degree in health care related field required or completion of a relevant bachelors degree with in two (2) years of hire.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Registered Nurse License (California)
Basic Life Support
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 management skills.
Good oral and written communication skills.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Supervisory or leadership experience in Case Management preferred.
Five (5) years as an IP Case Manager preferred.
CCM or other certification preferred.
Experience/understanding of SNF and continuing care placement options preferred.
COMPANY: KAISERTITLE: Supervisor Utilization ManagementLOCATION: Riverside, CaliforniaREQNUMBER: 1296234External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.