title: may include some travel witin the serivce area.
- position will develop and lead multi-dimensional perfomrance improevment program to reduce overall costs, and enhance service and quality for our patients and members in external hospitals.) to enusre high quality & cost-effetcive discharge planning
- supports um stfaf in negotiating barriers or systems issues to expedite pateint services during the hospital stay
- accountable for oversight of um activities (e.ncqa, state, cost effectiveness, service and quality, and other loacl, problem-solving and analytical skills
- strong people skills andcase management experience
- strong background in project management and performance improvement with demonstrated accomplishments in large systems to enhance efficiency, the jonit commsision,
- a minimum of 3 years of experience in management /leadreship in a hospital or outpatient setting
- a minimum of 3 years of experience in utilization management activities required
- bsn or ba in health care related field or equivalent experience required
- graduate of accredited school of nursing
- master\'s degree preferred
- current california rn licensure
- knowledge of the nurse practice act, and federal regulations
- demonstrated skills in leading and facilitating the efforts of multidisciplinary groups
- demonstrated strong communication.behavioral health, etc) into efforts to improve quality of care/service & reduce costs
- collaborates w/ interdisciplinary teams across the continuum of care including, ccm, snf, tpmg sub-specialty departments, msw, hh, g. care paths, rehabilitation, etc, nursing, pt/ot, hospice, but not limited to (hbs, innovative discharge planning/case management models.manager utilization management
location: modesto, coordinates, & manages the administrative & operational activities that are directly associated w/ the utilization management of medcial services proivded to kaiser\'s members, ca
this position develops.
- position will primarily be located in downtown modesto.
- may be asked to provide coverage at other kfh facility in cva depending on needs.cms, clinically appropriate, safe & cost effective
- ensrues compilance w/ regualtory/accredtiation (ncqa, etc, mdqr, the joint commission, ) to ensure patient care is effecitvely provided, dmhc, service orineted, medcial, dol.it wokrs indepednently & estabilshes prioirties for staff, in addtiion.) for tredning & develpoment of performance improvement inititaives
- parnters w/ the um cheif & kfh/tpmg local medical cetner leadership, to enagge the following areas in the development & implementation of a comprehensive utilization management, work plan to meet or exceed medical center targets
- identifies & incorporates (as appropriate) evidence-based best/successful practices (e.etc, patient care coordinators, discharge planners, ) requirements related to um by partnering w/ other departments & facilitating workgroups in maintaining survey readiness
- directs staff review of the um related aspects of treatment & discharge plans (case managers.
- chairs & co-chairs local committees focused on creating, pdr\'s, implementing & monitoring work plans to achieve um targets & performance improvement
- shares accountability w/ other medical center leadership for the daily monitoring of utilization indicators & performance, etc, los, including um peer, readmissions, identification & escalation of problems, other departments & contracted/planned providers
- manages projects related to chart reviews & conducts utilization data analysis (avoidable days, um chiefs/directors, quality, prs reports, one-day stays, tpmg, & initiation & evaluation of action plans for achieving medical center targets & improve the quality of care & services
- participates & provides um expertise on local & regional committees, drg\'s, umab.midas, employee, department safety, & monitors departmental policies & procedures
- position will lead operational work case managing outside claims and referrals, hiring, other criteria/guidelines), & terminations integrated into the broader service area utilization management initiatives
- manages department budget & finances & develops, & ambulance
- may be responsible for oversight of coordination of care in planned & contract hospitals/providers
- consultation & collaboration w/ tpmg/kfh medical center leadership to ensure discharge-planning activities are hr related activities
- manages & resolves human resource, & risk management issues
- responsible for all aspects of staff management including, g, performance reviews, implements, & the denial process
- may be responsible for claims management, the appropriate use of interqual, repatriation, development/training.