Resource Stewardship Manager

Provides day to day management of a team comprised of nurses, referral processors and support staff with accountability for referral entry, clinical review of referral requests and coverage determinations. Accountable for compliance with policies and procedures, compliance with referral processing protocols, compliance with SOX controls, process efficiency and exceptional service to members and physicians. Manages represented staff in compliance with Kaiser Permanente's Labor Management Partnership.
Essential Responsibilities:
Analyzes data and facilitates issue identification and problem resolution.Creates and maintains an effective team with accountability for an efficient, service-oriented, timely regulatory compliant and accurate process for receipt and entry of referrals into the system, clinical review, and UM decision making.Insures accurate benefit and eligibility management as defined in the member's Evidence of Coverage and in compliance with state and federal regulations.Coordinates with various internal and external customers to facilitate high quality, timely, and cost effective care and service.Contributes to organizational planning through participation in inter and intra regional projects. Chairs or participates on region wide teams, task forces and committees to develop recommendations on issues which can range from small, localized to broader, region wide issues with significant and critical impact.Establishes a collaborative working relationship with appropriate managers within the organization to help identify and facilitate operational changes needed to improve and/or support functional processes dependent on the work of the referral management team.Ensures that coverage determinations are made in compliance with statutes, regulations, and accreditation standards and polices.Maintains current information and knowledge of all applicable Kaiser policies, local, state and federal laws and regulations, and accreditation standards.Ensures that the training activities incorporate all applicable KP policies, local, state and federal laws and regulations, and accreditation standards.Coordinates care with various internal and external customers to facilitate high quality, timely, and cost effective care and service.Supervises assigned staff. This includes interviewing, selecting, training, motivating, evaluating, counseling, disciplining and terminating in compliance with EEO/AA goals and personnel policies of the organization.Establishes a collaborative working relationship with appropriate managers to help identify and facilitate operational changes needed to improve and/or support care delivery for members.Local travel between care centers and/or facilities required.
Basic Qualifications:
Experience
At least five (5) years of clinical experience in hospital or outpatient setting.
Education
High School Diploma OR General Education Diploma (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Effective interpersonal and communication skills required.Leadership experience, including management of human resource issues and strong decision-making skills.Knowledge of Medicare coverage guidelines and medical criteria such as Interqual or Milliman.Knowledge of quality and utilization review methods, and statistical techniques.
Preferred Qualifications:
Managed care experience preferred.Currently licensed as a Registered Nurse in the State of Colorado OR certified as a Physician Assistant by the NCCPA preferred.

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