Utilization Management Director jobs in Oakland, CA
Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Utilization Management Director jobs
Utilization Management Director
- Alameda Health Consortium/Community Health Center...
-
San Leandro, CA
FULL_TIME
-
Organizational Description
The Community Health Center Network (CHCN) is a partnership between eight health service organizations in Alameda County, whose mission is to provide a comprehensive range of professional health care in a manner respectful of the community values and traditions. CHCN is a nonprofit corporation, serving as an agent for its member health service organizations. CHCN provides administrative support to the Alameda Health Consortium (AHC).
Position Title: Utilization Management Director
Department: Healthcare Services
Reports To: Chief Medical Officer
Classification: Exempt
Status: Full Time Regular
Salary Range: $133,400 to $176,800 yearly
POSITION SUMMARY
The UM Director oversees the staff and activities of the Utilization Management (outpatient and inpatient) and Basic Case Management programs. They develop, update, review and provide oversight of Utilization Management and Care Management processes, policies and procedures, ensuring compliance with applicable federal, state and delegated health plan requirements. Responsible for all Management Services Organization (MSO) delegated requirements.
ESSENTIAL POSITION RESULTS
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.
Provide oversight for utilization management including: representation at health plan meetings and audits; development and maintenance of utilization management and case management plans, policies, procedures, and reports.
Serve as a leader and role model for the UM department and the MSO, working in close partnership with staff, medical officers, business operations, finance, quality and other departments/divisions of the organization.
Conduct training for staff and the organization on UM related matters.
Responsible for effectively managing the Care Management program including program development, staff training and support, and work with external partners.
Supervise Utilization Management Supervisors (outpatient and inpatient), Basic Case Management team, and other teams as the organization requires, such as UM Quality Improvement.
Responsible for the oversight of processing of prior authorizations, concurrent and out-of-plan reviews, and denials according to regulatory and internal standards.
Work with the team to support quality improvement program studies, access audits, and member/provider satisfaction surveys.
Collaborate with the appropriate data analytics team to plan and guide the analysis of required management and MSO reports.
Collaborate with the IT department on improvements to the MSO software systems used by the UM and other teams.
Oversee the response to clinically related grievances with appropriate team members, ensuring clinically accurate and timely responses according to timelines set in regulatory standards.
Respond to all audit findings in a professional and timely manner.
Oversee the UM Department budget, developing the annual budget in collaboration with supervisors and the medical team, ensuring fiscal responsibility in spending, and sound financial planning acumen.
Collaborate with the CMO and Medical Officers to develop and present regular reports for the monthly UM Committee.
Serve as the clinical management representative on the CHCN data team.
HIPAA Designated Access
For the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets
X1. MSO MembershipX2. MSO ClaimsX3. MSO Referral/AuthX4. MSO Capitation
5. Data WarehouseX6. Chart Audit/QI
SUPERVISORY RESPONSIBILITIES
Yes
MINIMUM QUALIFICATIONS
Education & Experience
Active and unencumbered RN license in the State of California
3 years in Utilization Management / Quality Improvement in hospital, HMO, or IPA setting, preferably with the Medi-Cal Managed Care and Medicare Managed Care fields.
2 years in health care delivery at hospital, clinic, facility, or providers office.
Excellent written and verbal communication skills, including customer relationship management.
3 years of staff supervision. Strong management experience is a requirement.
Computer literacy. Knowledge of MSO software systems is a must.
Sound decision-making skills for clinical and non-clinical issues.
Ability to lead, train and coach others.
Strong financial management skills.
California drivers license and reliable transportation required.
General CHCN Roles:
Fosters an environment that promotes trust and cooperation among clients and staff.
Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.
Accountable for participating in decision making processes and understanding the outcome(s).
Understands the values and principles of CHCN and applies them in work responsibilities.
Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.
Attends UM Committee meetings and CHCN Board of Directors meetings, as required.
CERTIFICATES AND/OR LICENSES
RN
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.
WORKING CONDITIONS AND ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly exposed to an inside/outside environment.
The Community Health Center Network is an Equal Opportunity Employer. - 2 Days Ago
Clinical Coordinator for Drug Utilization Management
- Clinical Management Consultants
-
Walnut Creek, CA
FULL_TIME
- A prestigious 100 patient bed hospital in Northern California is searching for a highly motivated and experienced Clinical Coordinator to join their dynamic healthcare team. This is an exceptional opp...
- 5 Days Ago
Supervisor, Utilization Management
- Altais
-
Oakland, CA
FULL_TIME
- About Our Company At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, p...
- 2 Days Ago
Utilization Management (UM) Manager
- Alameda Health Consortium/Community Health Center...
-
San Leandro, CA
FULL_TIME
- https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e7de3ad3-98d5-4757-a74e-97b4ad6b0fdd&ccId=19000101_000001&type=JS&lang=en_US&selectedMenuKey=CareerCenter&jobId=485122
- 8 Days Ago
Manager Utilization Management
- Kaiser
-
El Cerrito, CA
FULL_TIME
- 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...
- 28 Days Ago
Manager Utilization Management
- Kaiser
-
Diablo, CA
FULL_TIME
- 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...
- 28 Days Ago
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0 Utilization Management Director jobs found in Oakland, CA area
Executive Assistant to Managing Director
- The Hire Standard
-
San Francisco, CA
- 04th April, 2024 Our client, a dynamic and expanding venture capital firm based in San Francisco is actively seeking an ...
- 4/25/2024 12:00:00 AM
Global Marketing Communications Manager/Director
- Hesai Technology
-
Palo Alto, CA
- Company Overview: Empower Robotics, Elevate Lives! Hesai LiDAR is a leading technology company specializing in LiDAR (Li...
- 4/24/2024 12:00:00 AM
Senior Relationship Manager - Managing Director
- Deutsche Bank
-
San Francisco, CA
- Job Description: Job Title Senior Relationship Manager Corporate Title Managing Director Location San Francisco and Los ...
- 4/23/2024 12:00:00 AM
Manager/Director, Corporate Development & Strategy
- Oruka Therapeutics
-
San Francisco, CA
- ***Please read full instructions on how to apply; San Francisco Bay Area, CA or Boston Area, MA; hybrid working model **...
- 4/23/2024 12:00:00 AM
Director, Managing Director- 401K Relationship Manager
- Fidelity TalentSource LLC
-
San Francisco, CA
- Job Description: Role The Managing Director (MD) is entrusted with a book of business of defined contribution. The Manag...
- 4/23/2024 12:00:00 AM
Global Marketing Communications Manager/Director
- Hesai Technology
-
Palo Alto, CA
- Company Overview: Empower Robotics, Elevate Lives! Hesai LiDAR is a leading technology company specializing in LiDAR (Li...
- 4/22/2024 12:00:00 AM
Manager/Director, Corporate Development & Strategy
- Oruka Therapeutics
-
San Francisco, CA
- ***Please read full instructions on how to apply; San Francisco Bay Area, CA or Boston Area, MA; hybrid working model **...
- 4/21/2024 12:00:00 AM
US Region Sales Manager/Director
- SMI Silicon Motion
-
Milpitas, CA
- **US Region Sales Manager/Director** Milpitas The primary responsibility is to generate, retain and expand sales revenue...
- 4/21/2024 12:00:00 AM
About Oakland, California
Oakland is in the eastern region of the San Francisco Bay. In 1991 the City Hall tower was at 37°48′19″N 122°16′21″W / 37.805302°N 122.272539°W / 37.805302; -122.272539 (NAD83). (The building still exists, but like the rest of the Bay Area, it has shifted northwest perhaps 0.6 meters in the last twenty years.)
The United States Census Bureau says the city's total area is 78.0 square miles (202 km2), including 55.8 square miles (145 km2) of land and 22.2 square miles (57 km2) (28.48 percent) of water.
Oakland's highest point is near Grizzly Peak Blvd, east of Berkeley, just over 1,760 feet (...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$154,407 to $208,790
Oakland, California area prices
were up 4.5% from a year ago
were up 4.5% from a year ago
What does a Utilization Management Director do?
Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020