Utilization Management Director Job at Ami Network, Pasadena, CA

LzdHMHFHaGVsZTBJQUZPcjZzNzlDaCtj
  • Ami Network
  • Pasadena, CA

Job Description

  • Compensation: $140,000.00 - $180,000.00 per year
  • Required Qualifications:

AMI Network is partnered with a large healthplan organization to find their next Utilization Management Director in Pasadena.

Our client is a leading Health Plan + IPA that offers full-service Medicare Advantage coverage across multiple counties in California, currently serving over 60k+ members from major Health Plans like Anthem, SCAN, and Alignment Health.

As the Utilization Review Director, you'll oversee 4 direct reports on the IPA side (UM supervisors + coordinator), and play a crucial role in providing operational leadership to the UM/Prior Authorization and Inpatient Teams (50 FTEs in total). You’ll be responsible for CMS + Health Plan audits, and ensuring compliance with Federal, State, Health Plan, and NCQA requirements.

This role offers a competitive salary in the ballpark of $180k (give or take based on experience) -Plus great benefits: 3 weeks PTO, 8 Holidays, 401k + matching, HMO or PPO Medical/Dental, vision, and life insurance.

This is an onsite position- no remote options are available at this time.

Requirements:

  • Healthplan Experience + Medicare Advantage
  • 3-5 years Management Experience
  • RN in CA
  • Daily audits of UM until they are in full compliance - CMS + Health Plan audits

APPLY NOW if you're interested in taking the next big step in your career!

#J-18808-Ljbffr

Job Tags

Remote work,

Similar Jobs

Goodhue Boat Company

General Sales Manager Job at Goodhue Boat Company

 ...their fullest potential. We are looking for a Full-Time, General Sales Manager to help us in delivering award-winning customer service and...  ...more years of sales management experience in the boating, automotive, or recreational craft industry. ~ Excellent interpersonal... 

Zaxby's

Cashier Job at Zaxby's

 ...than just a place to eat its a place to have fun, spend some time with friends and experience great food. To our team members, Zaxby...  ...the point of sale system Accept payments, operate cash registers, and maintain receipts Handle cash payments, count... 

Vertiv Group Corp.

TIG Welder-(Weekends) Job at Vertiv Group Corp.

 ...POSITION SUMMARY We are seeking a skilled and safety-focused Welder/Fabricator to join our manufacturing team. This role is responsible...  ..., grinders, or other appropriate tools. Perform MIG and/or TIG welding along adjoining edges of workpieces using appropriate... 

Doctronic

Remote MD Medical Content Reviewer Flexible Hours Job at Doctronic

 ...seeks a qualified medical reviewer to ensure clinical accuracy and factual correctness of pre-written medical blog posts. This fully remote position offers competitive hourly compensation ranging from $100200, allowing for a flexible schedule. Candidates must have an MD... 

Fusion HealthCare Staffing

Radiology - Interventional Physician Job at Fusion HealthCare Staffing

Radiology - Interventional Physician at Fusion HealthCare Staffing summary: The Interventional Radiology Physician provides specialized 90% interventional and 10% general radiology services including procedures like myelograms, arthrograms, venograms, biopsies, and ...