Utilization Management Director

• Compensation: $ - $ per year

•

Required Qualifications:

AMI Network is partnered with a large health plan organization to find their next Utilization Management Director in Pasadena.

Our client is a leading Health Plan + IPA that offers full-service Medicare Advantage coverage across multiple counties in California, currently serving over 60k+ members from major Health Plans like Anthem, SCAN, and Alignment Health.

As the Utilization Review Director, you'll oversee 4 direct reports on the IPA side (UM supervisors + coordinator), and play a crucial role in providing operational leadership to the UM/Prior Authorization and Inpatient Teams (50 FTEs in total). You’ll be responsible for CMS + Health Plan audits, and ensuring compliance with Federal, State, Health Plan, and NCQA requirements.

This role offers a competitive salary in the ballpark of $180k (give or take based on experience)
-Plus great benefits: 3 weeks PTO, 8 Holidays, 401k + matching, HMO or PPO Medical/Dental, vision, and life insurance.

This is an onsite position- no remote options are available at this time.

Requirements:

• Health plan Experience + Medicare Advantage

• 3-5 years Management Experience

• RN in CA

• Daily audits of UM until they are in full compliance - CMS + Health Plan audits

APPLY NOW if you're interested in taking the next big step in your career!

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