Utilization Management Director - Pasadena - AMI Network

    AMI Network
    AMI Network Pasadena

    23 hours ago

    $140,000 - $260,000 (USD) per year *
    Description
    • Compensation: $140, $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.

    If your skills, experience, and qualifications match those in this job overview, do not delay your application.

    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. xhmxlyz

    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

    * This salary range is an estimation made by beBee
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