Director of Utilization Management (Behavioral Health)

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An established behavioral health hospital is seeking a Director of Utilization Management to lead its Utilization Management program. This high-impact leadership role offers the chance to collaborate with respected clinical teams and make a meaningful difference in patient care, regulatory compliance, and reimbursement optimization.

Director of Utilization Management Benefits & Compensation:

• Competitive compensation and comprehensive benefits package
• Executive-level position with organization-wide visibility
• Opportunity to drive improvements in clinical and financial outcomes
• Collaborative, supportive leadership culture
• Stable, mission-driven organization committed to behavioral health

Director of Utilization Management Requirements & Qualifications:

• Current California RN license required
• 5+ years of leadership experience in Utilization Management or Utilization Review
• Experience in behavioral health, psychiatric hospital, or acute care settings
• Strong knowledge of behavioral health utilization management, concurrent review, denial management, appeals, and reimbursement
• Experience with Medi-Cal, Medicare, commercial payers, and California behavioral health regulations
• Proven leadership, communication, and team development skills

Director of Utilization Management Preferred Background & Skills:

• Familiarity with Carelon Behavioral Health and Orange County behavioral health systems

Director of Utilization Management Day-to-Day Responsibilities:

• Lead all Utilization Management and Utilization Review operations
• Supervise and develop Utilization Management and Social Services teams
• Oversee concurrent review, payer authorizations, appeals, denial management, and reimbursement optimization
• Ensure compliance with California regulations, Medi-Cal, Medicare, commercial payers, and accreditation standards
• Collaborate with physicians, clinical leadership, and care teams to improve patient flow, length of stay, and discharge planning
• Build and maintain relationships with managed care organizations, county agencies, and community providers
• Monitor utilization trends, quality metrics, and financial performance to drive process improvements
• Provide education and support to clinical staff on utilization management best practices

Join a respected leader in behavioral health and help shape the future of patient care through strategic leadership and partnership.

JOB ID: 177981

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Stacey Balzer

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