Description

You will oversee utilization management and care management programs for delegated services across California Medi-Cal and Medicaid markets, driving quality, efficiency, and regulatory compliance while leading a team of directors.

Requirements

• Bachelor's in business, healthcare administration, nursing, or related field
• 10+ years MSO operations experience with 5+ years in national/regional management
• Experience in change management and process improvement
• Registered Nurse license preferred

Responsibilities

• Lead and develop UM/CM Directors, setting direction and accountability
• Oversee daily UM operations including prior authorization, concurrent and retrospective review
• Ensure compliance with federal, state, health plan, and NCQA requirements
• Manage inpatient and complex care management programs
• Identify opportunities to reduce unnecessary utilization while maintaining quality