Director of Utilization Management

3 days ago

Orange, California, United States Alignment Healthcare Full time
Job Title: Director, Utilization Management

Alignment Healthcare is seeking a highly skilled and experienced Director, Utilization Management to lead our clinical services operations. As a key member of our leadership team, you will be responsible for providing strategic direction and oversight to our utilization management functions across all markets.

Key Responsibilities:
  • Develop and implement strategies to improve population health, patient experience, and healthcare costs
  • Lead a team of clinical professionals to manage medical utilization and ensure compliance with regulatory requirements
  • Collaborate with cross-functional teams to develop and implement clinical programs and initiatives
  • Monitor and analyze key performance metrics to inform business decisions and drive improvement
  • Build and maintain strong relationships with key stakeholders, including physicians, hospitals, and payers
Requirements:
  • 5-6 years of experience in clinical services and/or health plan care management functions
  • Significant experience in case management, utilization management, and population health with solid knowledge of best practices in all aspects of medical management
  • Proven ability to use medical management metrics and develop data-based initiatives to improve outcomes
  • Leadership and management experience, with a proven track record of success in leading high-performing teams
  • Active LVN or RN license required; bachelor's degree in a health-related field preferred
What We Offer:
  • A dynamic and growing organization with a mission to transform healthcare for seniors
  • A collaborative and supportive work environment with opportunities for professional growth and development
  • A competitive salary and benefits package, including medical, dental, and vision coverage
  • A 401(k) retirement plan with company match
  • Generous paid time off and holidays

Alignment Healthcare is an Equal Opportunity/Affirmative Action Employer. We welcome applications from diverse candidates and are committed to creating an inclusive work environment.

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