Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
The Manager, Utilization Management position is responsible for overseeing and managing the day-to-day operations of the Utilization Management Department, health plan delegated activities, and medical management initiatives. This position works closely with the Director, Medical Director, and VP to evaluate and monitor referral and care coordination activities. Responsible for developing and implementing strategic plans which will have a direct impact on cost containment and improved patient outcomes. Should possess comprehensive knowledge of managed care industry standards, familiarity with government regulations, expertise in interpreting full-service health plan contractual DOFR and delegation logic requirements, in-depth understanding of regulatory and accreditation compliance, and experience in medical management program development.
Minimum Requirements
1. Bachelor’s Degree in a health affiliated or business affiliated field required.
2. Minimum of 5 years of managed care experience, including Medi-Cal managed care, Medicare and Commercial insurance payor systems that preferably includes health plan level required.
3. Knowledge of various accreditation standards, such as NCQA or URAC, Etc.
4. Knowledge of healthcare & managed care industry current and future trends, to assess future market needs.
5. Strong computer proficiency (MS Office) and typing skills are necessary.
6. Knowledge of State and Federal regulations required.
Compensation
$97,534.47 - $121,918.09 annually
Compensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
Job Advertisement & Application Compliance Statement
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
