Utilization Management Assistant Director - RN

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

Create a Job Match for Similar Jobs

At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.

Connections working at UCLA More Jobs from This Employer Return to Search Results