Nurse Manager - Utilization Review & Case Management

Essential Responsibilities

• Aids in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management.
• Collaborates with multi-disciplinary teams to plan and coordinate care across the continuum.
• Captures 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.
• Affirms 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.
• Aids in conducting statistical studies in utilization trends, patterns, and outcomes.

Basic Qualifications

• Minimum three years of experience in utilization management and discharge planning in an acute care setting to also include supervisory or management experience.
• Three years of case management experience to include some supervisory or leadership experience.
• BSN or bachelor's degree in healthcare related field such as management, health services administration.
• Registered Nurse License (California).

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.