Director, Utilization Management

Summary

• 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 holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.

DUTIES & ESSENTIAL JOB FUNCTIONS

NOTE : Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

MINIMUM QUALIFICATIONS

Required Education

Bachelor's degree in Nursing

Preferred Education

Master's degree in Nursing

Required Experience

Three years of utilization review experience. Health insurance company and / or acute care hospital, post-acute and psych; three years of InterQual and / or MCG. Strong clinical nursing background.

Required Licenses / Certifications

Valid license to practice as a Registered Nurse in the State of California.

Preferred Licenses / Certifications

UM / CM certifications

Highland General Hospital

SYS Utilization Management

Full Time

Day

Nursing

FTE : 1