Utilization Management Director jobs in Anaheim, CA

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Utilization Management Assistant - Utilization Management
  • Providence
  • Anaheim, CA OTHER
  • Description

    Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals requested from providers.

    Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

    Required qualifications:

    • 1 year' Experience in a hospital, health insurance company or medical office/clinic setting.

    Preferred qualifications:

    • Coursework/Training: College level classes, preferably in healthcare or related field or

    • Associate's Degree in Healthcare or related field.

    • Medical Assistant Certification (CMA) upon hire.

    • 1 year' Experience in utilization management or case management with experience in medical terminology and coding.

    Why Join Providence?

    Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

    About Providence

    At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

    The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

    Check out our benefits page for more information about our Benefits and Rewards.

    About the Team

    Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

    PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St. John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

    We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

    We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

    We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

    Requsition ID: 239189
    Company: Providence Jobs
    Job Category: Health Information Management
    Job Function: Revenue Cycle
    Job Schedule: Full time
    Job Shift: Day
    Career Track: Admin Support
    Department: 7520 UTIL MGMT CA HERITAGE
    Address: CA Anaheim 200 W Center St Promenade
    Work Location: St Joseph Home Health-Anaheim
    Pay Range: $20.22 - $31.50
    The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

    Check out our benefits page for more information about our Benefits and Rewards.

    Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

  • 28 Days Ago

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Utilization Management Reporting Specialist
  • HealthSmart Management Service Organization, Inc.
  • Cypress, CA FULL_TIME
  • POSITION SUMMARY: This position works under the direction of the VP, Medical Management in support of ensuring reporting and compliance with the Utilization Management and Quality Management Plans and...
  • 18 Days Ago

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Senior Director Medical Management
  • Max Populi, LLC
  • Cerritos, CA FULL_TIME
  • Our client is a Fortune 50 company that has an integrated healthcare model that is proving to be successful in the market. We are seeking a Director of Medical management who will report into the CMO ...
  • 18 Days Ago

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Director of Risk Management
  • WKS Restaurant Group
  • Cypress, CA FULL_TIME
  • Pay Range: $125,000 - $140,000 per year Listed wages are based on company-wide ranges. Actual earnings will vary based on factors such as: restaurant brand, experience, education, geography, applicabl...
  • 20 Days Ago

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Director, Materials Management
  • AHMC Healthcare
  • Anaheim, CA OTHER
  • Overview This position is responsible for all materials management activities, i.e., demand/utilization management, order management, supplier management, logistics management, and inventory/ assets m...
  • 1 Month Ago

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Director, Client Management_Kerry
  • Acosta Group
  • Chino, CA FULL_TIME
  • **Do you have a passion for food?** Are you looking for a company where you can learn, grow, and WIN? CORE Foodservice is a North American Foodservice Sales Agency that blends engaged leadership with ...
  • 1 Month Ago

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0 Utilization Management Director jobs found in Anaheim, CA area

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Managing Director
  • COREcruitment Ltd
  • Los Angeles, CA
  • Managing Director - Entertainment Los Angeles $200,000 - $250,000 My client is an amazing, rapidly growing entertainment...
  • 4/25/2024 12:00:00 AM

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Managing Director, Professional Staffing
  • Century Group
  • Glendale, CA
  • Job Description Job Description About Us: Century Group is an award-winning recruiting and staffing firm that provides t...
  • 4/25/2024 12:00:00 AM

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Product Management Director
  • ClientSolv Technologies
  • Los Angeles, CA
  • Company Description ClientSolv Technologies is an IT solution firm with over a decade of experience serving Fortune 1000...
  • 4/23/2024 12:00:00 AM

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Sustainability Manager/ Director
  • Six Senses Ninh Van Bay
  • San Clemente, CA
  • Scope of Work :As Sustainability Manager, I fully comprehend the vision of Six Senses to help people reconnect with them...
  • 4/23/2024 12:00:00 AM

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SOX Managing Director
  • CNM LLP
  • Los Angeles, CA
  • Job Description Job Description We are currently searching for a Managing Director to join our high performing SOX team ...
  • 4/22/2024 12:00:00 AM

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Managing Director
  • Corecruitment Ltd
  • Los Angeles, CA
  • Managing Director - Entertainment Los Angeles $200,000 - $250,000 My client is an amazing, rapidly growing entertainment...
  • 4/22/2024 12:00:00 AM

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Managing Director - Construction Disputes
  • LVI Associates
  • Los Angeles, CA
  • LVI are currently seeking a senior-level construction manager or engineer to provide direction and exceptional leadershi...
  • 4/22/2024 12:00:00 AM

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Managing Director - Construction Disputes
  • Lvi Associates
  • Los Angeles, CA
  • LVI are currently seeking a senior-level construction manager or engineer to provide direction and exceptional leadershi...
  • 4/21/2024 12:00:00 AM

Anaheim (/ˈænəhaɪm/) is a city in Orange County, California, part of the Los Angeles metropolitan area. As of the 2010 United States Census, the city had a population of 336,265, making it the most populous city in Orange County and the 10th-most populous city in California. Anaheim is the second-largest city in Orange County in terms of land area, and is known for being the home of the Disneyland Resort, the Anaheim Convention Center, and two major sports teams: the Anaheim Ducks ice hockey club and the Los Angeles Angels baseball team. Anaheim was founded by fifty German families in 1857 and...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$140,359 to $189,793
Anaheim, California area prices
were up 3.2% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020