Description
UCLA HEALTH
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Description
Join a world-class healthcare organization and play a key leadership role in delivering high-quality, patient-centered care. UCLA Health is seeking a dynamic and experienced Utilization Management Assistant Director to oversee Intensive Case Management (ICM) and Utilization Management (UM) operations focused on high-risk and complex patient populations. In this leadership role, you will supervise a multidisciplinary team supporting patients across the continuum of care while driving operational excellence, regulatory compliance, and improved patient outcomes. This is an exciting opportunity for a collaborative healthcare leader passionate about care coordination, utilization management, and value-based care. Key Responsibilities
- Provide day-to-day leadership and oversight of Intensive Case Management (ICM) and Utilization Management (UM) programs
- Supervise and mentor a multidisciplinary team including Registered Nurses, Social Workers, and care coordination staff
- Oversee care coordination activities for high-risk, high-utilizer, oncology, Medicare Advantage, and specialty patient populations
- Lead transitions of care, discharge planning, readmission prevention, and emergency department tracking initiatives
- Ensure compliance with CMS, NCQA, and organizational policies related to utilization management and case management
- Monitor operational and clinical performance metrics including readmission rates, ED utilization, and length of stay
- Conduct staff coaching, onboarding, training, and performance evaluations
- Collaborate with physicians, hospital leadership, post-acute providers, and community agencies to ensure seamless patient care transitions
- Support utilization review activities for hospital, rehabilitation, skilled nursing, and home health settings
- Partner with revenue cycle and appeals teams to support denial prevention and medical necessity documentation
- Drive process improvement initiatives focused on quality outcomes, patient experience, and cost-effective care delivery
- Promote patient-centered, culturally competent, and holistic care across all care settings
Salary Range: $116,300 – $264,600/AnnuallyQualifications
All items are required:
- Current unrestricted RN licensure in CA required
- Bachelors of Science, Nursing (BSN) degree required
- Experience Minimum 5-7 years of clinical experience, with at least 3 years in case management or utilization management
- Minimum 3-5 years in a leadership or supervisory role
- Experience in Managed Care Organization, Medical Group or Health Plan
- Strong knowledge of CMS guidelines, utilization management, and care coordination
- Ability to multi-task, work with frequent interruptions, and meet deadlines. Must be detailed, oriented, attentive, organized, and able to follow directions.
- Proficient computer skills including working knowledge of Microsoft Excel, Visio, Power P and Word.
- Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners and mailing equipment.
- Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally.
- Highly organized, reliable, consistently seeking learning opportunities and new challenges, High EQ, communication skills, problem solving ability, and teamwork, humble yet confident, peers feel comfortable requesting your assistance.
Preferred:
- Experience in Medicare Advantage or value-based care models