Director, Utilization Management

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

The Utilization Management Director (UMD) position is responsible for the development and implementation of AltaMed’s utilization management strategic plan, by providing leadership, direction, and support for Utilization Management (UM) functions that focus on the evaluation of medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan and in compliance with industry regulatory provisions as they pertain to UM delegation. The UMD provides oversight of the utilization review staff and determines policies and procedures that incorporate best practices in conducting concurrent reviews, prior authorizations, and or retrospective activities that are predicated on ensuring member care coordination is conducted timely, in the right setting, and is cost-effective and quality-driven. UMD leadership is incumbent on providing a functional UM infrastructure that is fundamentally driven through staff education, training, and the provision of adequate resources to effectuate optimal outcomes in productivity and excellence. The Director measures UM activities outcomes through the application of innovative strategies and analytics to support the measurement of UM trends, patterns and impacts to resources to validate they are meeting UM goals and objectives.

Minimum Requirements

• Bachelor’s degree in Nursing preferred, plus a minimum of five years experience in managed care at the hospital or insurance industry level with at least 2 years of experience in a supervisory capacity or its equivalent required.

• Experience in managing employees in remote locations is highly desirable.

• A current valid license as a registered nurse through the California Board of Registered Nursing is required.

• Experience with E.H.R. and utilization management IT systems is highly desirable.

• A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

Compensation

$148,243.60 - $185,304.51 annually

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days 
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.