Supervisor Utilization Management
Primary Location Los Angeles, California
Worker Location Onsite
Facility Los Angeles Medical Center
Job Number 1351709 Date posted 04/18/2025
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Description:
The Supervisor Utilization Management will assure compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements and will provide oversight and direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care to ensure patient care quality. The Supervisor will also assist in conducting statistical studies in utilization trends, patterns, and outcomes to ensure compliance with all regulatory standards.
Job Summary:
The Supervisor Utilization Management will assure compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements and will provide oversight and direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care to ensure patient care quality. The Supervisor will also assist in conducting statistical studies in utilization trends, patterns, and outcomes to ensure compliance with all regulatory standards.
Essential Responsibilities:
- Provides direction and supervision to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care.
- Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management.
- Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
- Provides coaching to the staff regarding performance and attendance issues and assists in performance evaluations.
- Surfaces issues and make any suggestions to the appropriate multi-disciplinary team members.
- Trains and educates the staff on policies and procedures within the UM department.
- Attends various meetings related to the UM department.
- Assists in managing various UM related projects and maintain statistical data related to the projects and assists in Quality improvement projects.
- Assists in the management of the attendance program and provide coaching, scheduling and maintains vacation modules.
- Assists in conflict resolution and corrective actions.
- Assists in conducting statistical studies in utilization trends, patterns, and outcomes.
- Tracks and manages the use of overtime within the department and will coach staff related to high utilization of overtime.
- Indirectly manages the budget by reviewing the utilization of FTEs, overtime, and non-payroll usage.
- May be required to cover weekend supervision.
- Performs Competency evaluations.
- Assumes other activities and responsibilities as needed.
Basic Qualifications:
Experience
- Minimum one (1) year of experience in utilization management and/or discharge planning in an acute care setting.
- Minimum one (1) year leadership experience in utilization management or healthcare related field.
Education
- BSN OR bachelors degree in health care related field required or completion of a relevant bachelors degree with in two (2) years of hire.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Registered Nurse License (California)
- Basic Life Support
Additional Requirements:
- Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, Medi-Cal and other local, state and federal regulations.
- Knowledge of managed care operations.
- Demonstrated interpersonal, negotiation, and management skills.
- Good oral and written communication skills.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Supervisory or leadership experience in Case Management preferred.
- Five (5) years as an IP Case Manager preferred.
- CCM or other certification preferred.
- Experience/understanding of SNF and continuing care placement options preferred.
Notes:
• Every other weekend.
Primary Location: California,Los Angeles,Los Angeles Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Team Leader/Supervisor
Department: Sunset Medical Center - Utilization Management - 0801
Pay Range: $122900 - $158950 / 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
On-site: Work location is on-site (KP designated office, medical office building or hospital).
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 fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.
Submit Interest
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
