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Description
title: develops & manages programs that emphasize approrpiate admissions as well as concurrent & retrospective review of care.
- bsn or ba or bs degree in healthcare related field such as management, health services administration.
- effective oral and written communication skills.cpur preferred,
preferred qualifications:
- ccm.medi-cal,
- demonstrated knowledge of opertaions and healthcare management; jchao, title xxii, and other local, state, medicare, and federal regulations.excel, and powerpoint,
- experience in ms word.may also be responsible for other integrated funcitons such as discharge planning, outisde utilization review program, interdisciplinary process in the continuum of care, coordinated, transportation coordination & extended care coordination to promote a centralized, case management program.ncqa, tpmg, divisional, administrative stfaf, development implementation, other regulatory agencies, & controls department\'s budgets
- assures compliance w/ federal, monitors, trains, & disciplines staff to ensure smooth operations in utilization management
- also facilitates educational training for medcial staff on issues related to utilization management
qualifications:
basic qualifications:
- current california rn license, & internal standards & requirements
- hires,
essnetial functions:
- proivdes ovearll diretcion, coahces, jcaho, deisgn, patetrns, & imapct to appropriate deparmtental & medical staff commtitees
- may dierct 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 w/ outside vendors
- develops, & monitoring of utilization programs to meet the service area\'s or medical center\'s utilization goals while maintaining customer satisfaction
- acts as a resource to the medical staff, state, & 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 & medical necessity
- analyzes & reports significant utilization trends, scpmg.
- three (3) - five (5) or more years of experience in directing utilization management and discharge planning in an acute care setting.
- knowledge of managed care operations.negotiation,
- demonstrated interpersonal, and leadership skills.
- relevant master\'s degree in a related field such as nursing, business or health services administration preferred.& directs the utilization management programs in a service area or a medical center, ca
develops, director utilization management
location: panorama city, manages.
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