Director OF Utilization Management

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 UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart. #J-18808-Ljbffr