Manager - Utilization Management

We are seeking an experienced Utilization Management Manager to join our team at Kaiser Permanente. This is an exciting opportunity for a professional who has a talent for making sound decisions to ensure quality care at the lowest cost. You will be responsible for leading a team of Utilization Management Specialists in the utilization of resources for our members.The ideal candidate is an excellent communicator who is able to build strong relationships with internal and external stakeholders. You must have the ability to think critically, analyze complex data, and come up with creative solutions to improve outcomes.The successful candidate must have a Bachelor’s degree in Nursing or related field, as well as 5+ years of experience in managed care, utilization, or case management. A strong working knowledge of medical terminology, CPT/ICD-10 coding, and reimbursement methodologies is essential.We are looking for a detail-oriented individual who is passionate about delivering exceptional patient care. If you are excited about having a meaningful impact on the lives of our members, we would love to hear from you.

Responsibilities:

• Lead and manage a team of Utilization Management Specialists in the utilization of resources for members.
• Oversee the evaluation of medical necessity and appropriateness of care in accordance with medical policy, industry standards, and regulatory requirements.
• Utilize data to identify opportunities for improvement in care delivery, cost savings, and quality of care.
• Develop and maintain strong relationships with internal and external stakeholders to ensure the successful implementation of initiatives.
• Monitor and report utilization trends and variances to ensure compliance with established policies and procedures.
• Identify and resolve potential utilization issues and provide feedback to enhance performance.
• Maintain a working knowledge of medical terminology, CPT/ICD-10 coding, and reimbursement methodologies.
• Develop and implement strategies to improve patient care, outcomes, and cost savings.
• Monitor and analyze utilization data to ensure quality of care and cost-effectiveness.
• Ensure compliance with all regulatory and accreditation standards.
• Provide guidance and direction to Utilization Management Specialists regarding the utilization review process and case management.

According to JobzMall, the average salary range for a Manager - Utilization Management in Downey, CA, USA is $74,500 to $116,500 per year. This range includes base salary plus bonus, commission, and other compensation, as reported by employers.

Kaiser Permanente is an American integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield.