This position is responsible for comprehensive Inpatient and Emergency Department Utilization Review/Case Management (UR/CM) Program. The ANDA provides leadership and direction to staff members to accomplish program and organizational goals. The ANDA works closely with UR/CM CND and CNO to ensure coordination of services for a smooth continuum of care process throughout the organization.

Through the department’s work, the Director will help identify and implement changes in caregiver practice patterns to maximize quality patient care, patient satisfaction and resource utilization.

RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

• Establishes, implements, and evaluates a strategic plan and goals for the department that take into account internal and external factors.
• Directs utilization review/case management activities for the hospital, interfacing with external payers to determine appropriate medical necessity of admissions and continued hospitalizations.
• Identifies appropriate staffing levels, assignments, role descriptions and performance criteria for staff members.
• Identifies measures and creates reports that display critical outcome factors for discussion with hospital leadership.
• Establishes and maintains effective relationship with individual physicians, clinical departments and diagnostic/ancillary services.
• Develops and implements operational standards, policies and procedures.
• Ensures quality management, fiscal accountability and outcome measures.

Qualifications

DESIRABLE QUALIFICATIONS:

• Prior experience with Utilization Review/Management.
• Recent experience in an acute care hospital.
• Strong communication and critical thinking skills.
• Flexibility and willingness to participate in organizational and process change.
• Experience in a hospital utilization review and/or case management program.

About the Hospital

The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. Through its integrated system of 25 health centers and four acute care hospitals - and expanded network of community partner clinics – DHS annually provides direct care for 600,000 unique patients, employs over 23,000 staff, and has an annual budget of over $6.9 billion.