Utilization Management (Skilled Nursing Facility) ...

Description: Job Summary:Responsible for leading and managing the Utilization Management team, processes and procedures focused on appropriate Skilled Nursing Facility utilization. Role will ensure compliance with national, and state regulatoryaccreditation requirements related to utilization management by partnering with other departments and facilitating workgroups in maintaining survey readiness to ensure that all annual requirements are met.Essential Responsibilities:Leads the SNF Utilization Management Department with a strong leadership presence and engagement to support the ongoing development and performance of everyone on the team.Manages the day-to-day utilization management function of a team or teams of clinicians ensuring the accurate and timely prior authorization of designated healthcare services, including concurrent and retrospective review of authorization requests.Runs daily, weekly, monthly, and ad hoc reports to monitor and analyze department performance, assess data against standards and goals, and identifies trends as appropriate.Manages and oversees the utilization review management training and education program for Utilization Review staff across the region.Works to develop, enhance and ensures workflows, policies, and procedures to support the efforts within the SNF utilization management team.Accountable for outcomes including, but not limited to skilled nursing admits per 1,000, and length of stay, escalation percentages, physician discordance rates, expected discharges dates, management of LOS 16+.Participates as a subject matter expert (SME) in internal cross-functional teams to ensure that utilization management programs meet regulatory requirements and elevates risk to leadership when programs are not in compliance. As well as ensures regulatory requirements are met and has continuous collaboration with quality and compliance teams.Manages regulatory audits including policy and file preparation.Collaborates and communicates with Patient Care Coordinators, Utilization Management Operations Center, MAPMG Physicians, and Health Plan leaders to develop, implement, and operate Utilization Management Activities.Partners with the Post-Acute Care Utilization Senior Director to develop and implement the staffing, education, mentoring, information technology, and data needed to enable post-acute care teams to successfully provide care to KP members.Regularly gathers data and utilization management metrics to support continuous improvement on the prioritized post-acute performance metrics. Collaborates with the Senior Director of Post-Acute Care Utilization in supporting organizational goals.Other duties as assigned. Basic Qualifications: Experience Minimum Two (2) years of supervisory experience. Education Bachelors degree of Science in Nursing (BSN) from four (4)-year college or university, two (2) years- experience in UM or related field; OR Associate Degree in Nursing (ADN) with a minimum of five (5) years of experience in UM or related field. License, Certification, Registration NA Additional Requirements:Strong aptitude in data analytics, technology, and relationship building.Experience in post-acute programs (SNF, IRF, LTAC, Home Health, Hospice). Preferred Qualifications: Certification Training Specifically Focused on utilization management preferred.Masters degree in related field preferred. Primary Location: Maryland,Hyattsville,New Carrollton Administration Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 PM Working Hours End: 04:30 PM Job Schedule: Full-time Job Type: Standard Worker Location: Flexible Employee Status: Regular Employee GroupUnion Affiliation: NUE-MAS-01|NUE|Non Union Employee Job Level: Manager with Direct Reports Department: Regional Office - Med Ofc Adm-Clncal Suppt Svcs - 1808 Pay Range: $109100 - $141130 year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing. Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

Created: 2025-02-23