Summary
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Role Overview:
\n\nAlameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.
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DUTIES & ESSENTIAL JOB FUNCTIONS : NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
\n\nMINIMUM QUALIFICATIONS :
\n\nRequired Education: Bachelor’s degree in Nursing
\n\nPreferred Education: Master’s degree in Nursing
\n\nRequired Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.
\n\nRequired Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.
\n\nPreferred Licenses/Certifications: UM / CM certifications
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