Regional Utilization/Resource Management Executive job in Pasadena, CA| Recruit Arrow
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Regional Utilization/Resource Management Executive
Location : California, Pasadena
Refer job # NDKJ336691
Job Responsibilities and Requirements: Essential Functions: Provide executive level leadership, strategic direction and recommendations regarding a comprehensive Regional UM/Resource Management plan. Provides expertise and operational leadership and consultation to SCAL executive leaders, SCPMG, and the fourteen SCAL medical centers regarding Utilization/resource management. In conjunction with regional and local leaders, develops the structures, processes, metrics and accountabilities across the full continuum of care to ensure that patients receive the right care that they need in the right setting at the right time. Partners with SCPMG Physician leaders regarding the successful implementation of the IQM model throughout all SCAL. Strategic Planning: In conjunction with regional and medical center leadership, develops a strategic plan for appropriate use of services across the continuum of care. Anticipates and plans for future changes in Utilization/Resource Management practices and regulatory requirements. Leadership & Direction: Identifies and institutes performance improvement efforts based on evidence based research, practices and patient outcomes. Facilitates the rapid transfer of best practices among the SCAL medical centers. Serves as a knowledgeable content expert regarding utilization management regulations, practices, and compliance. Finance: Understands the finances of various care settings and contributes ideas and plans for efficient utilization of resources appropriately. Program Development: Directs program planning and development from a regional level to benefit the local medical centers. Provides oversight to ensure that policies, procedures and practices comply with administrative, legal and regulatory requirements. Basic Qualifications:Experience Substantial experience (10 years) progressive operational experience in clinical and leadership roles in a mulit-faceted health care system and multi-provider settings. Recent (within last 6 years) experience at a medical center. Substantial relevant and progressive experience (8 years) in utilization/resource management.Education Masters degree in nursing, health services, business administration or public health/administration. Bachelors degree in one of the above.License, Certification, Registration N/A. Additional Requirements: Demonstrated knowledge of the intricacies of hospital/HMO/medical offices operations and practices. Demonstrated knowledge of Medicare, Medicaid, SNP Thorough knowledge of health care policy trends, resource management and regulatory and licensing requirements. Preferred Qualifications: California RN license strongly preferred.
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