To Apply for this Job Click Here
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
#post
Stacey Balzer