Utilization Management Assistant Director - RN

Description

Join a world-class healthcare organization and play a key leadership role in delivering high-quality, patient-centered care. UCLA Health is seeking a dynamic and experienced Utilization Management Assistant Director to oversee Intensive Case Management (ICM) and Utilization Management (UM) operations focused on high-risk and complex patient populations.

In this leadership role, you will supervise a multidisciplinary team supporting patients across the continuum of care while driving operational excellence, regulatory compliance, and improved patient outcomes. This is an exciting opportunity for a collaborative healthcare leader passionate about care coordination, utilization management, and value-based care.

Key Responsibilities

• Provide day-to-day leadership and oversight of Intensive Case Management (ICM) and Utilization Management (UM) programs
• Supervise and mentor a multidisciplinary team including Registered Nurses, Social Workers, and care coordination staff
• Oversee care coordination activities for high-risk, high-utilizer, oncology, Medicare Advantage, and specialty patient populations
• Lead transitions of care, discharge planning, readmission prevention, and emergency department tracking initiatives
• Ensure compliance with CMS, NCQA, and organizational policies related to utilization management and case management
• Monitor operational and clinical performance metrics including readmission rates, ED utilization, and length of stay
• Conduct staff coaching, onboarding, training, and performance evaluations
• Collaborate with physicians, hospital leadership, post-acute providers, and community agencies to ensure seamless patient care transitions
• Support utilization review activities for hospital, rehabilitation, skilled nursing, and home health settings
• Partner with revenue cycle and appeals teams to support denial prevention and medical necessity documentation
• Drive process improvement initiatives focused on quality outcomes, patient experience, and cost-effective care delivery
• Promote patient-centered, culturally competent, and holistic care across all care settings

Salary Range: $116,300 - $264,600/Annually

Qualifications

All items are required:

• Current unrestricted RN licensure in CA required
• Bachelors of Science, Nursing (BSN) degree required 
• Experience Minimum 5-7 years of clinical experience, with at least 3 years in case management or utilization management
• Minimum 3-5 years in a leadership or supervisory role 
• Experience in Managed Care Organization, Medical Group or Health Plan
• Strong knowledge of CMS guidelines, utilization management, and care coordination
• Ability to multi-task, work with frequent interruptions, and meet deadlines. Must be detailed, oriented, attentive, organized, and able to follow directions. 
• Proficient computer skills including working knowledge of Microsoft Excel, Visio, Power P and Word.
• Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners and mailing equipment. 
• Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally.
• Highly organized, reliable, consistently seeking learning opportunities and new challenges, High EQ, communication skills, problem solving ability, and teamwork, humble yet confident, peers feel comfortable requesting your assistance.

Preferred:

• Experience in Medicare Advantage or value-based care models

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At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.

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