Director Utilization Management

3 weeks ago


San Diego, United States AMI Network Full time

I’m partnered with a major health plan in San Diego to find a Director of Utilization Management


This top-rated Medicaid Health Plan touches over 400,000 lives with plans to continue growing while maintaining excellent quality ratings.


That’s where you come in. Check out some details:


  1. You get to work with the #1 Medicaid Health Plan in San Diego County.
  2. You’ll be stepping into squeaky clean automation and crystal-clear processes overseeing a team of 25.
  3. You’ll get to work under a CEO who cares more about member satisfaction than Bob Ross does about his paintbrush.


If going above and beyond is your game- you’ll be in the right place. They’re rated #1 locally, and plan to continue that recognition nationally. The COO doesn’t settle for great (can you say 24/7 live customer service?).



The c-suite is rock-solid with all of them being in place for over 10 years, so you know you’ll be stepping into stability and look forward to growth within the company.


If being part of an organization where you can make change in the lives of people who need it the most, I would urge you to have an exploratory conversation.



Check out the details:

  • Location in Chula Vista
  • 25 direct reports (both inpatient and outpatient UM)
  • Build excellent relationships with hospital Case Managers and Discharge Planners
  • Oversee staff productivity and ensure excellence in all processes and reports
  • Report to the Senior Director of Healthcare Services


What would make a stellar candidate:

  • Well-versed with the health-plan space (Managed Care, MSO, or IPA experience optional)
  • Specific experience with Medi-Cal is a HUGE bonus
  • Plenty of years in Utilization Management experience
  • Knowledge of NCQA, Medicaid, CCS etc.


Have to Haves:

  • Registered Nurse (RN) License in the state of CA



Let’s continue this conversation to see if this role would be exactly what you need to get out of burn-out and into inspiring that “spark” inside of you



Click “Apply” today


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