Director of Managed Services

4 weeks ago

Pasadena CA, United States Ami Network Full time

Required Qualifications: AMI Network is partnered with a large healthplan organization to find their next Utilization Management Director in Pasadena. Our client is a leading Health Plan + IPA that offers full-service Medicare Advantage coverage across multiple counties in California, currently serving over 60k+ members from major Health Plans like Anthem, SCAN, and Alignment Health. As the Utilization Review Director, you'll oversee 4 direct reports on the IPA side (UM supervisors + coordinator), and play a crucial role in providing operational leadership to the UM/Prior Authorization and Inpatient Teams (50 FTEs in total). Youll be responsible for CMS + Health Plan audits, and ensuring compliance with Federal, State, Health Plan, and NCQA requirements. 3 weeks PTO, 8 Holidays, 401k + matching, HMO or PPO Medical/Dental, vision, and life insurance. This is an onsite position- no remote options are available at this time. 3-5 years Management Experience
~ Daily audits of UM until they are in full compliance - CMS + Health Plan audits

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