Utilization Management Assistant Director - RN

Utilization Management Assistant Director – RN Location: Los Angeles, CA Salary Range: $116,300 – $264,600 annually Work Hours: Monday – Friday, 8:00am – 5:00pm PST; schedule may vary including weekends and holidays Employment Type: 2 – Staff-Career Duration: Indefinite Posted Date: May 29, 2026 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 #J-18808-Ljbffr Veterans in Healthcare