Utilization Management Expert
7 days ago
Alameda Health System is seeking an experienced Director of Utilization Management to lead our operations team.
About the Role
- This is a full-time position at Highland General Hospital.
- The ideal candidate will have 3 years of experience in utilization review, preferably with a health insurance company or acute care hospital.
- A strong clinical nursing background and knowledge of InterQual and/or MCG are essential.
Responsibilities
The Director of Utilization Management will be responsible for:
- Leading a team of utilization review professionals and providing guidance, training, and performance evaluations.
- Monitoring and evaluating the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures.
- Analyzing data and generating reports on utilization trends, outcomes, and quality indicators to support decision-making and process improvement initiatives.
- Developing and implementing utilization review policies and procedures in accordance with industry standards and regulatory requirements.
- Fostering effective communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process.
Requirements
- Bachelor's degree in Nursing.
- Valid license to practice as a Registered Nurse in the State of California.
- Preferred education: Master's degree in Nursing.
- Preferred certification: UM/CM certifications.
Salary and Benefits
We offer a competitive salary range of $120,000 - $150,000 per year, depending on experience, plus benefits including 100% employer-paid health plan for employees and their eligible dependents, unique benefit offerings, rich retirement plans, and generous paid time off plans.
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