Exciting direct hire opportunity for a full time RN Utilization Management Director in San Fernando, CA!

Job Duties:



The Utilization Management Director will be responsible for developing, coordinating and directing the clinical and operational activities that are directly associated with the utilization management of medical services provided.
The Director is accountable for the compliance and efficiency measures of the UM Department for all lines of business and all functional areas.
They will oversee complex case management and special needs population interventions and other clinical activities.
Position responsibility also includes developing and maintaining constructive working relationships with providers, health plans, hospitals and regulatory agencies.




Job Requirements:

BSN or BA or BS degree in healthcare related field preferred.
Current CaliforniaRN License required.
Clinical understanding of hospital and ambulatory patient care delivery systems required.
Minimum 5 years experience in utilization management, discharge planning, ambulatory case management, quality management or clinical area in a managed care setting, preferably a health plan or medical group with 2 years in a management role.
Demonstrated knowledge of operations and managed care operations. Knowledge of California Health and Safety Act, NCQA, DMHC, CMS and DHS regulations.

If you are interested in this Utilization Management Director job please apply online or send your resume directly to Kimberly.Jewett@adeccona.com for immediate consideration!

Adecco Medical & Science is a specialized medical division of the Swiss owned company Adecco SA, the 4th largest employer in the world. Our strengths in nursing, paramedical, pharmacy, technical support staff and quality assurance, give us a global platform from which to serve our many Clients.