Utilization Management Inpatient Clinical Manager RN

Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #2086
Tuesday, August 15, 2023
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications.  A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization.  Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the position of Utilization Management Inpatient Clinical Manager RN in the range of $113,198 – $143,639 annually.
 

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Primary Purpose:

Under the supervision of the Director of Utilization Management, this position manages, leads, acts as a subject matter expert, and provides guidance on unit functions and departmental operations, including clinical health outcomes related to acute care services, post-acute care, care coordination and transition of care management, clinical data management and retrieval, reporting standards and State policy and procedure implementation. Develops implements and evaluates clinical programs related to organizational initiatives. The incumbent has supervisor responsibilities over employees which include mentoring, coaching, problem solving, conducting performance evaluations, hiring, training, performance management, and disciplinary actions.

 

Supervises:

  • Yes

 

Distinguishing Characteristics:

  • Lead and supervise the performance and responsibilities of all inpatient UM department staff.
  • Ensure the ongoing efficiency, clinical integrity, cost effectiveness, and departmental and organizational integration of the UM department.
  • Positively and collaboratively participate in the formation and implementation of departmental and corporate strategic planning efforts.
  • Represent the UM department in Leadership meetings.
  • Work with the Utilization Management Director to actively recruit, hire, and oversee the onboarding and training for new inpatient UM department staff.
  • Work with the UM department clinical trainers and leads to coordinate training and professional development needs and goals.
  • Monitor and administer UM department staff involving the following performance metrics and analytics: Monitor the work queues and adjust duties as needed for optimal performance, perform special projects as needed, oversee management of employee timecards and time-off requests for accuracy, ensure completion of quality audits for departmental staff quarterly, adjust schedules as needed, address and troubleshoot problems, issues, and challenges as they arise, conduct 1x1 meetings with department staff at regular intervals, complete regular performance reviews on all assigned UM department staff, document employee related information and performance feedback in appropriate systems, administer performance improvement plans as needed for UM department staff who are not meeting performance expectations utilizing appropriate collaboration with the Director and Human Resources.
  • Prepare reports and conduct analysis of operations / services as required by departmental, corporate, regulatory, and State requirements.
  • Assist in preparation, coordination, and follow up of Inpatient Utilization Management audits, such as readiness review and DHCS site visits, pertaining to the Inpatient Utilization Management Department activities.
  • Partner with community agencies and contracted vendors to develop and maintain collaborative contact to assure members have access to the appropriate resources and to avoid duplication of efforts.
  • Chairs and Co-chairs local committees focused on creating, implementing, and monitoring work plans to achieve UM targets and performance improvement. Provides expertise into target setting processes. Shares accountability with other leadership for the daily monitoring of utilization indicators and performance, identification and escalation of problems, and initiation and evaluation of action plans for achieving goals and targets and improve the quality of care and services.
  • Participates and provides UM expertise on local and regional committees, including UM Peer, UM Chiefs/Directors, Quality, other departments and contracted/planned providers.
  • Manages projects related to chart reviews.
  • Conducts utilization data analysis for trending and development of performance improvement initiatives. Partners with the UM Director in the development and implementation of a comprehensive utilization management work plan to or exceed all regulatory requirements.
  • Identifies and incorporates (as appropriate) evidence-based best/successful practices (e.g. care paths, innovative discharge planning / case management models, etc.) into efforts to improve quality of care/service and reduce costs.
  • Collaborates with interdisciplinary teams across the continuum of care.
  • Manages HR related duties in partnership with the UM Director and Human Resources including Employee/Department safety, and risk management issues. Responsible for all aspects of staff management including, hiring, development/training, verification of all licensed staff credentials, performance reviews and terminations.
  • Assists with the management of the department budget and finances.
  • Assists in the development, implementation and monitoring of departmental policies and procedures.
  • Comply with Corporate, Federal, and State confidentiality standards to ensure the appropriate protection of member identifiable health information.
  • Perform other duties as assigned.

 

Core Competencies/Knowledge & Skill Requirement:

  • Thorough knowledge of the healthcare industry, principles of healthcare planning, process and outcomes measurement, principles and practices of utilization management and clinical health outcomes.
  • Working knowledge of the principles and practices of managed care, healthcare regulatory processes, medical terminology and related procedures, and diagnostic coding.
  • Working knowledge of State and Federal legislative processes
  • Working knowledge of the principles and practices of program development, project management, customer service, records management and supervision and training.
  • Working knowledge of and proficiency with Windows based PC systems and Microsoft Word, Excel (including advanced spreadsheet applications), Outlook, PowerPoint, and database software
  • Some knowledge of Medi-Cal, Title 22, Knox Keene, Medicare, and related regulations.
  • Ability to assume responsibility and exercise sound judgment when making decisions in the absence of the Director.

Employment Standards

Education:

  • Possession of an active, current, unrestricted California RN license.
  • Bachelor of Science in Nursing (BSN) from an accredited school of nursing or relevant health care field required.
  • Master of Science degree in Nursing or relevant field is preferred.
  • Certification in Case Management (CCM) or (ACM) is desired.

 

Experience:

  • 5 years of clinical knowledge and experience, required.
  • 1 year leadership experience, required.
  • 3 years of previous experience involving Utilization Management and/or Case Management, preferred.
  • Strong supervisory and people management experience, required.
  • Ability to effectively communicate, both in verbal and written form.
  • Ability to use a computer and quickly learn and master different software platforms as needed to perform assigned tasks and responsibilities.
  • Self-motivated with the ability to take initiative and work effectively in both an independent and collaborative business environment.

Other Requirements:

  • Possession of valid California Driver’s License and proof of valid State required auto liability insurance. Required travel up to 10%.
  • Ability to use a computer keyboard and mouse 6-8 hours per day.
  • Ability to dial, answer, and talk on a telephone with a headset for 6-8 hours per day.
  • Ability to engage in sedentary activity by sitting or standing at a workstation for 6-8 hours.
  • Ability to lift and transport office and computer equipment between office and home; less than 20 pounds.
  • This is an “in- office” designated position.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

Other details

  • Pay Type Salary
  • Min Hiring Rate $113,198.00
  • Max Hiring Rate $143,639.00
  • Travel Required Yes
  • Travel % 10
  • Telecommute % 0
  • Required Education Bachelor’s Degree
Location on Google Maps
  • Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America