Utilization Management Expert

7 days ago


Oakland, California, United States Alameda Health System Full time

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:

  1. Leading a team of utilization review professionals and providing guidance, training, and performance evaluations.
  2. Monitoring and evaluating the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures.
  3. Analyzing data and generating reports on utilization trends, outcomes, and quality indicators to support decision-making and process improvement initiatives.
  4. Developing and implementing utilization review policies and procedures in accordance with industry standards and regulatory requirements.
  5. 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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