Director - Utilization Management

3 weeks ago

California, United States Apollo Medical Holdings, Inc. Full time
Job Title: Director, Utilization Management
Department: Health Services - UM About the Role: Leads and shapes the Utilization Management (UM) Strategy for Astrana Health while providing management oversight in implementing, directing, and monitoring the Utilization Management Department functions, including prior authorizations, concurrent review, medical claims review, and appeals and grievances. Directs the Utilization Management Department, acts as a subject matter expert, and provides executive level advice and guidance on the Department’s functions and overall business operations. Directs, manages and supervises Utilization Management Department staff. This is a hybrid role where the expectation is to work both in office and from home on a weekly basis. What You'll Do:
  • Develop and implement strategies for optimizing the utilization of healthcare resources while maintaining quality patient care
  • Create, implement, and enforce UM policies and procedures in accordance with regulatory requirements and best practices
  • Provide strategic leadership, development, and supervision to utilization review department
  • Lead and manage a team of UM staff
  • Oversee the UM process which involves evaluating medical necessity and appropriateness of healthcare services, treatments, and procedures
  • Monitor and evaluate quality of UM activities, ensuring compliance with established standards and identifying areas of improvement
  • Utilize data analytics and reporting tools to track key utilization metrics, identify trends, and make data-driven decisions to optimize resource utilization
  • Collaborate with internal stakeholders and external stakeholders to promote understanding and support for UM initiatives
  • Provide training and education to staff members on UM policies, procedures, and best practices
  • Collaborate with finance and administrative teams to develop and manage budgets related to UM operations
Minimum qualifications:
  • Bachelor's degree in nursing, Master's degree preferred
  • 7+ years demonstrating proven track record of strategic planning in managed care environment
  • 7+ years of experience with UM
  • Strong leadership and communication skills
  • Experience managing projects, including developing project plans, identifying and solving blockers, and reporting on status
  • Strong data analysis skills
  • Genuine interest in transforming the healthcare industry
Who We Are: Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system. Our Values:
  • Patients First
  • Empowering the Independent Provider
  • Be Innovative
  • Operate with Integrity & Deliver Excellence
  • Team of One
Environmental Job Requirements and Working Conditions:
  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive in Monterey Park, CA.
  • The target pay range for this role is between $150,000.00 and $160,000.00. This salary range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. #J-18808-Ljbffr

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