The Director of Commercial Utilization Management plays a pivotal role at Blue Shield of California by leading utilization management strategies, ensuring compliance, and optimizing care for Commercial members. This position requires strong leadership and analytical skills to drive operational efficiencies and enhance patient care.
Key Responsibilities
Manage and monitor prior authorization and concurrent review
Lead development of UM strategy using data/analytics
Provide analysis and reports on utilization trends
Establish and measure productivity metrics
Ensure alignment of authorization strategy with clinical policy
Manage strategic projects and support operations initiatives
Lead operational implementation of transformation changes