Director, UM Inpatient
About The Position
The Utilization Management Director (UMD) position is responsible for the development and implementation of AltaMed’s utilization management strategic plan, by providing leadership, direction, and support for Utilization Management (UM) functions that focus on the evaluation of medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan and in compliance with industry regulatory provisions as they pertain to UM delegation. The UMD provides oversight of the utilization review staff and determines policies and procedures that incorporate best practices in conducting concurrent reviews, prior authorizations, and or retrospective activities that are predicated on ensuring member care coordination is conducted timely, in the right setting, and is cost-effective and quality-driven. UMD leadership is incumbent on providing a functional UM infrastructure that is fundamentally driven through staff education, training, and the provision of adequate resources to effectuate optimal outcomes in productivity and excellence. The Director measures UM activities outcomes through the application of innovative strategies and analytics to support the measurement of UM trends, patterns and impacts to resources to validate they are meeting UM goals and objectives.
Requirements
- Bachelor’s degree in Nursing preferred, plus a minimum of five years experience in managed care at the hospital or insurance industry level with at least 2 years of experience in a supervisory capacity or its equivalent required.
- A current valid license as a registered nurse through the California Board of Registered Nursing is required.
- A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.
Nice To Haves
- Experience in managing employees in remote locations is highly desirable.
- Experience with E.H.R. and utilization management IT systems is highly desirable.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Director
