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/Annually

Qualifications

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

Utilization Management Assistant Director - RN

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