Director of Utilization Management

1 month ago


Bakersfield, United States All’s Well Full time

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.



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