Utilization Management Nurse Director
7 days ago
The Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes.
The Utilization Management Nurse Director will join a respected acute-care institution consistently recognized for quality, patient safety, and community impact, with accolades that reflect national standards of excellence. The Utilization Management Nurse Director will benefit from modern clinical technologies, advanced EHR optimization, data-driven utilization analytics, and a culture that champions continuous improvement, care equity, and meaningful partnerships that strengthen the health of diverse communities.
The Utilization Management Nurse Director will lead within a comprehensive Case Management Department supporting a hospital designated as a Stroke Center, a Cardiac Center, and a high-performing Orthopedics program. The Utilization Management Nurse Director will collaborate across service lines to streamline care coordination, drive appropriate status determinations, reduce avoidable days, enhance transitions of care, and support evidence-based practice for complex, high-acuity populations.
The Utilization Management Nurse Director will report to senior nursing leadership and partner closely with physician advisors, revenue cycle, quality, and finance, while guiding a skilled team of utilization review nurses and case management professionals. The Utilization Management Nurse Director will oversee utilization review strategy, regulatory readiness, denial prevention and appeal processes, LOS and throughput initiatives, criteria adherence (InterQual/MCG), documentation alignment, and interdisciplinary rounding, all within a collaborative culture of friendly nurses and a diverse healthcare professional team committed to patient-centered excellence.
The Utilization Management Nurse Director will thrive in Northern California's vibrant setting, with waterfront trails, redwood parks, world-class concerts and festivals, acclaimed museums, and a dynamic dining scene featuring global cuisine and farm-to-table freshness. The Utilization Management Nurse Director will enjoy easy access to the broader Northern California lifestyle-from Napa and Sonoma wine country to Pacific coast escapes, from Yosemite and Lake Tahoe adventures to bustling Bay Area culture-enhanced by mild, year-round weather and convenient regional transit.
The Utilization Management Nurse Director will be offered a competitive salary up to $200,000, commensurate with experience, along with a full suite of health benefits, retirement plans with employer contributions, generous paid time off, and opportunities for professional development. The Utilization Management Nurse Director candidates are invited to connect with a Clinical Management Consultants recruiter for a confidential conversation and to learn more about this exceptional leadership opportunity-step forward and lead the future of hospital utilization management today.
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Director, Utilization Management
14 hours ago
San Francisco, CA, United States Alameda Health System Full timeSummary 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer-paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management...
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Director, Utilization Management
4 days ago
San Francisco, CA, United States Alameda Health System Full timeSummary 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer-paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management...
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Director, Utilization Management
3 days ago
San Francisco, CA, United States Alameda Health System Full timeSummary 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer-paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management...
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Director of Utilization Management
6 days ago
San Leandro, CA, United States Community Health Center Network Full timefalse false false EN-US X-NONE X-NONE Organizational Description The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for...
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Director of Utilization Management
2 weeks ago
San Leandro, CA, United States Community Health Center Network Full timefalse false false EN-US X-NONE X-NONE Organizational Description The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for...
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Director of Utilization Management
1 week ago
San Leandro, CA, United States Community Health Center Network Full timefalse false false EN-US X-NONE X-NONE Organizational Description The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for...
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Director of Utilization Management
3 days ago
San Leandro, CA, United States Community Health Center Network Full timefalse false false EN-US X-NONE X-NONE Organizational Description The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for...
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San Marino, CA, United States Imperial Health Plan of California, Inc. Full timeImperial is currently seeking a Registered Nurse with 2 to 3 years of clinical nursing background and 2 to 3 years of Utilization Review experience. The ideal nurse for this role would also be proficient in conducting peer-to-peer meetings, mitigation of denials, have a strong understanding of the preauthorization process, the revenue cycle, reducing...
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San Marino, CA, United States Imperial Health Plan of California, Inc. Full timeImperial is currently seeking a Registered Nurse with 2 to 3 years of clinical nursing background and 2 to 3 years of Utilization Review experience. The ideal nurse for this role would also be proficient in conducting peer-to-peer meetings, mitigation of denials, have a strong understanding of the preauthorization process, the revenue cycle, reducing...
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San Marino, CA, United States Imperial Health Plan of California, Inc. Full timeImperial is currently seeking a Registered Nurse with 2 to 3 years of clinical nursing background and 2 to 3 years of Utilization Review experience. The ideal nurse for this role would also be proficient in conducting peer-to-peer meetings, mitigation of denials, have a strong understanding of the preauthorization process, the revenue cycle, reducing...
