Manager Utilization Management - KORE1 Technologies
San Diego, CA
About the Job
KORE1, a nationwide provider of staffing and recruiting solutions, has an immediate opening for a Manager of Utilization Management.
What are the 3-4 non-negotiable requirements of this position?
California RN License
BSN Degree
3 years of case management experience to include some supervisory or leadership experience.
What are the nice-to-have skills?
Certified Case Manager
Master's Degree a plus
Management experience in a union environment
Experience in a large hospital, high volume setting
California RN License
BSN Degree
3 years of case management experience to include some supervisory or leadership experience.
What are the nice-to-have skills?
Certified Case Manager
Master's Degree a plus
Management experience in a union environment
Experience in a large hospital, high volume setting
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:
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.
Qualifications:
Basic Qualifications:
Experience
· Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
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, 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.
Notes:
· Rotating on-call after hours, including weekends and holidays.
Employee Status:
Regular
Travel:
Yes, 20 % of the Time
Job Level:
Manager with Direct Reports
Job Type:
Standard
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:
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.
Qualifications:
Basic Qualifications:
Experience
· Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
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, 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.
Notes:
· Rotating on-call after hours, including weekends and holidays.
Employee Status:
Regular
Travel:
Yes, 20 % of the Time
Job Level:
Manager with Direct Reports
Job Type:
Standard
ABOUT KORE1
Specializing in professional and technical recruiting, KORE1 is committed to supporting top IT, Engineering, Creative, Scientific, Accounting and Finance professionals in their career paths. We build deep relationships with leading companies, connecting them to exceptional talent every day. With extensive industry expertise and unmatched opportunities, our goal is to provide a unique experience for our contractors and consultants as they prepare for their next role. We are passionate about matching the right people with the right companies.
Specializing in professional and technical recruiting, KORE1 is committed to supporting top IT, Engineering, Creative, Scientific, Accounting and Finance professionals in their career paths. We build deep relationships with leading companies, connecting them to exceptional talent every day. With extensive industry expertise and unmatched opportunities, our goal is to provide a unique experience for our contractors and consultants as they prepare for their next role. We are passionate about matching the right people with the right companies.
Kore1 provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Kore1 complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Kore1 expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Kore1's employees to perform their job duties may result in discipline up to and including discharge.
Source : KORE1 Technologies
