Director of Utilization Management
1 month ago
Are you a visionary leader with a passion for enhancing healthcare quality and efficiency? Our rapidly growing managed care company in Bakersfield, California, is seeking an experienced Medical Director to helm our Utilization Department. This pivotal role requires a dynamic individual with extensive experience in managed care, utilization management, and a proven track record of driving clinical excellence and operational efficiency.
As the Medical Director, you will provide comprehensive oversight of the Utilization Review process under the Knox Keene license and Department of Health Care Services contract. The position integrates and coordinates services using continuous quality improvement initiatives to promote positive member outcomes. Frequent executive level reporting and tracking on department and individual team productivity is essential. The Director of UM assesses needs, plans, communicates, designs services and strategies to forward the mission and serve member needs. The Director provides strategic leadership, development, and supervision to utilization review department, provides inter-professional collaboration with facility-based case managers and discharge planners, and coordinates with all aspects of the company, including Claims and Member Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals.
You will do great in this role with the following:
Education:
Bachelors (BSN) from an accredited college or University in Nursing (BSN) or other
relevant health care field required. Master’s degree (MSN) preferred.
Possession of Current, active and unrestricted RN license for the state of California
Experience:
Minimum of Five (5) years of management level experience in Utilization Management
in a managed care environment or healthcare industry.
Minimum of five (5) years’ clinical experience in Utilization Review or Case
Management in a Health Plan or similar payer/provider setting (Hospital, Managed Care
network, etc.) and with community-based programs.
Knowledge of:
Utilization Management in a managed care environment
basic procedures utilized in claims processing in a managed care environment
medical reimbursement methodologies
Supervisory and training techniques.
Thorough knowledge of regulations and requirements related to utilization management
Perks:
Medical care, including prescriptions and behavioral health, at little to no cost to employees
Vision
Dental care, including orthodontics
Short term and long term disability insurance and company paid basic life and accidental death and dismemberment coverage
Employee Assistance Program (EAP)
Health care for Dependents
Retirement plans 457(b) and 401(a) plan
CalPERS
Paid Time Off (PTO) and an extended illness bank (EIB)
Employee discount programs
Other supplemental benefits
Our Benefits and Wellness Team provides training and professional development courses, including in-house training sessions, to help you navigate the best way to use your benefits.
Join us in shaping the future of healthcare in Bakersfield, and make a significant impact on the lives of the communities we serve.
We proudly host California State University and Bakersfield College. We offer a vibrant array of activities, including sporting events, concerts, museums, and theater. We're just 2 hours away from beautiful beaches and majestic mountains, and only 2 hours from the Los Angeles Metropolitan area, with its rich array of art, theater, and attractions.
-
Director Utilization Management
4 weeks ago
Bakersfield, California, United States Dignity Health Full timeOverviewThis position is remote within California, Nevada or Arizona, with a clear and current CA RN license.*The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services...
-
Director of Utilization Management
3 weeks ago
Bakersfield, United States Impresiv Health Full timeTitle: Director of Utilization Management Duration: Direct Placement Location: Bakersfield, CA Summary: The Director of Utilization Management (UM) provides comprehensive oversight of the Utilization Review process. The position integrates and coordinates services using continuous quality improvement initiatives to promote positive...
-
Director Utilization Management
4 weeks ago
Bakersfield, United States Dignity Health Full timeOverview This position is remote within California, Nevada or Arizona, with a clear and current CA RN license.* The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business...
-
Utilization Management Director
6 days ago
Bakersfield, California, United States Impresiv Health Full timeImpresiv Health is seeking a highly motivated and experienced Utilization Management Director to lead our team in ensuring efficient and effective healthcare delivery. As a key member of our leadership team, you will play a vital role in developing and implementing strategies that optimize resource utilization, enhance patient care outcomes, and drive...
-
Chief of Utilization Oversight
4 days ago
Bakersfield, California, United States Impresiv Health Full timePosition: Director of Utilization Management Employment Type: Direct Placement Location: Bakersfield, CA Overview: The Director of Utilization Management (UM) is responsible for the comprehensive administration of the Utilization Review process. This role involves the integration and coordination of services through continuous quality...
-
Vice President of Utilization Oversight
1 week ago
Bakersfield, California, United States Impresiv Health Full timeTitle: Director of Utilization Management Duration: Direct Placement Location: Bakersfield, CA Overview:The Director of Utilization Management (UM) plays a pivotal role in supervising the Utilization Review process. This position is responsible for integrating and coordinating services through continuous quality improvement initiatives aimed at enhancing...
-
Program Director
3 months ago
Bakersfield, United States Integrated Practice Management LLC Full timeJob DescriptionJob DescriptionDescription:Under the general supervision of the Chief Nursing Officer, the Program Director provides clinical/ guidance, support and development to the therapists, interns, addiction counselors, unlicensed case managers and mental health team. To provide insight, guidance, and leadership in developing and maintaining a...
-
Utilization Review Nurse
2 weeks ago
Bakersfield, United States Kern Medical Full timeKern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services...
-
Utilization Review Nurse
2 months ago
Bakersfield, United States Kern Medical Full timeKern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles.Kern Medical offers a range of primary, specialty, and multi-specialty services including high-risk pregnancy care, inpatient psychiatric services integrated...
-
Director of Software Engineering
4 weeks ago
Bakersfield, United States Healthcare Finance Direct LLC Full timeJob DescriptionJob DescriptionDescription:Are you EPIC?Do you have the ability to demonstrate, understand and apply HFD’s core purpose andvalues in all that you do? At HFD our core purpose is to help the underserved live healthier. In order to accomplish this mission, we must ensure that our team is aligned with our E.P.I.C. values: Excellence: Always...
-
Regional Director
1 day ago
Bakersfield, California, United States RadNet Bakersfield (Kern-Radiology) Full timeAbout RadNet Bakersfield (Kern-Radiology)We are a leading provider of high-quality radiology services, dedicated to delivering exceptional patient care and advancing the field of radiology.Job SummaryWe are seeking a highly skilled and experienced Regional Manager to join our team at RadNet Bakersfield (Kern-Radiology). As a Regional Manager, you will be...
-
Travel Nurse RN Utilization Review
1 day ago
Bakersfield, California, United States Talent4Health Full timeTalent4Health is seeking a travel nurse RN Utilization Review professional to join our team in a travel nursing role in California.Job Summary:We are looking for a skilled travel nurse RN Utilization Review professional to work with our clients in California. The ideal candidate will have experience in utilization review and discharge planning, as well as...
-
RN Inpatient Acute Case Management
4 weeks ago
Bakersfield, United States Heritage Provider Network Full timeJob Description Under the direction of the Vice President Hospital Based Services Inpatient / Outpatient, this position is responsible to Provide guidance and coordination for Utilization Review Department. Evaluate inpatient medical records using criteria and facilitate discharge plans and needs. The RN or LVN Inpatient Acute Case Manager will interact with...
-
Licensed Vocational Nurse Case Manager
1 week ago
Bakersfield, California, United States Integrated Practice Management LLC Full timePosition OverviewThe Licensed Vocational Nurse (LVN) Case Manager plays a crucial role in addressing both clinical and non-clinical requirements of members with significant health challenges. This position emphasizes a systematic, community-oriented, interdisciplinary approach to high-touch, person-centered care management.Key ResponsibilitiesThe LVN Case...
-
Licensed Vocational Nurse Case Manager
4 days ago
Bakersfield, California, United States Integrated Practice Management LLC Full timePosition OverviewThe Licensed Vocational Nurse (LVN) Case Manager plays a crucial role in addressing both clinical and non-clinical requirements of members with significant health challenges. This position emphasizes a systematic, community-oriented, interdisciplinary approach to care management, focusing on personalized and high-touch interactions.Key...
-
Promotions Director-KMYX
3 months ago
Bakersfield, United States Chavezfoundation Full timeThe Promotions Director for KMYX-Bakersfield, CA proactively manages all the Marketing and Promotion activities for KMYX. Responsibilities: Develop and execute the Quarterly Marketing Strategy for KMYX. Work monthly to track expenses and adhere to expense guidelines. Manage the promotion and marketing budget not to exceed expenses unless preapproved by the...
-
Director of Educational Services
1 month ago
Bakersfield, California, United States California Department of Education Full timeRequirements/Qualifications Statement of Faith consistent with vision and mission of the school; A minimum of 5 years experience at a secondary school or private, faith based institution is preferred. About the Employer The educational experience at BCHS seeks to develop each student's mind, body and spirit to his or her fullest potential through challenging...
-
Acute Care Case Management Registered Nurse
1 week ago
Bakersfield, California, United States Heritage Provider Network Full timeJob Overview Under the supervision of the Vice President of Hospital-Based Services, this role is tasked with overseeing the Utilization Review Department. The RN or LVN in Acute Care Case Management will evaluate inpatient medical records using established criteria and facilitate discharge planning and requirements. This position requires interaction with...
-
Wildland Firefighter
1 day ago
Bakersfield, California, United States Bureau of Land Management Full timeJob SummaryWe are seeking a highly skilled and experienced Wildland Firefighter to join our team at the Bureau of Land Management. As a Wildland Firefighter, you will play a critical role in preventing and suppressing wildfires, while also working to protect people, property, and the environment.Key ResponsibilitiesLead and direct suppression operations on...
-
Director of Social Services
1 day ago
Bakersfield, California, United States Telecare Full timeJob SummaryThe Director of Social Services is a key leadership position at Telecare, responsible for planning, implementing, and directing the Social Services Department. This department provides casework services to members served and their families, and the Director of Social Services manages a team of social workers and discharge planners.Key...