California Licensed Utilization Management Director

Job Summary

A company is looking for a Director of Utilization Management to lead the utilization management team and ensure optimal member outcomes.

Key Responsibilities

• Directs the utilization management team to ensure compliance with policies and procedures
• Reviews and analyzes utilization trends to enhance program effectiveness
• Develops strategies and manages the budget while collaborating with senior leadership

Required Qualifications

• Bachelor's degree and 7+ years of related experience, including management experience
• 4+ years of management experience preferred
• Expert knowledge of industry regulations, policies, and standards preferred
• RN - Registered Nurse - State Licensure preferred
• Experience in Concurrent Review is highly preferred