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Job Description
Join Alameda Health System as the Director of Utilization Management, where you'll lead a team to enhance patient care through strategic oversight and compliance. This critical role involves analyzing healthcare service utilization and optimizing resource use to ensure high-quality patient outcomes.
Key Responsibilities
Lead and manage a team of utilization review professionals
Monitor and evaluate healthcare service utilization
Analyze data and generate reports on utilization trends
Manage quality of performance criteria, policies and procedures
Develop and implement utilization review policies and procedures
Coordinate data gathering and record keeping as required
Foster communication and collaboration with internal departments and external agencies
Participate in interdisciplinary committees for quality improvement
Oversee secondary review process and assist with appeals
Prepare cost analysis reports for departmental budget
Provide educational programs for staff and physicians
Responsible for recruitment and evaluation of UM and administrative staff
Required Qualifications
Bachelor's degree in Nursing
Three years of utilization review experience
Experience in health insurance company and/or acute care hospital, post-acute and psych
Three years of InterQual and/or MCG experience
Valid license to practice as a Registered Nurse in California
Preferred Qualifications
Master's degree in Nursing
UM / CM certifications
Benefits & Perks
100% employer health plan for employees and eligible dependentsUnique benefit offerings partially or fully employer-paidRich retirement plansGenerous paid time off plans