Job Summary We are seeking an experienced and dynamic Director of Utilization Management to lead and oversee the utilization management (UM) program for our health plan. The Director of Utilization Management will be responsible for developing and implementing UM strategies, ensuring efficient and effective use of healthcare resources, and maintaining compliance with regulatory standards. The ideal candidate will have a strong clinical background, exceptional leadership skills, and a deep under
Supervisor, Behavioral Health (Utilization Management) CalOptima CalOptima Health is seeking a highly motivated an experienced Supervisor, Behavioral Health (Utilization Management) to join our team. The Supervisor Behavioral Health (Utilization Management) will be responsible for the daily operation of Behavioral Health Integration (BHI) Utilization Management (UM) functions. The incumbent will oversee the benefit's prior authorization, concurrent review processes and transition of care. The in
Supervisor, Behavioral Health (Utilization Management) CalOptima Health is seeking a highly motivated an experienced Supervisor, Behavioral Health (Utilization Management) to join our team. The Supervisor Behavioral Health (Utilization Management) will be responsible for the daily operation of Behavioral Health Integration (BHI) Utilization Management (UM) functions. The incumbent will oversee the benefit s prior authorization, concurrent review processes and transition of care. The incumbent w
QI Nurse Specialist (RN) (Utilization Management) CalOptima CalOptima Health is seeking a highly motivated an experienced QI Nurse Specialist (RN) (Utilization Management) to join our team. The Quality Improvement (QI) Nurse Specialist for Utilization Management (UM) is responsible for overseeing UM for CalOptima Health's direct network and delegated Health Network teams. The incumbent will be responsible for ensuring standards are met for operational and oversight compliance and UM operations a
