Vivo HealthStaff is looking for a Utilization Management Director in Woodland Hills, California.
Job Title: Director, Utilization Management
Location: Woodland Hills, CA
Type: Permanent Full-time
We are seeking a dynamic and experienced Utilization Manager to lead our high-volume operations. The Director of Utilization Management oversees prior authorization staff and nursing teams to ensure efficient, cost-effective intake and review of pre-certification referrals.
- Key responsibilities include managing workflows, maintaining regulatory compliance (CMS, DMHC), and supporting medical program objectives in collaboration with clinical leadership.
- The role serves as a primary liaison between providers, medical directors, and health plans while overseeing the professional claims review nurse team for medical necessity determinations.
- Operational duties involve preparing departmental reports, participating in Quality Assurance programs, and managing crises or unusual incidents.
Qualifications:
- Candidates require five years of progressive experience in prior authorization or a similar medical group setting, alongside proven project management and staff supervisory capabilities.
- RN license (California) OR a non-clinical candidate with a Bachelor’s degree.
- Proven track record in team leadership and process optimization.
- Drive employee development, mentoring, and engagement.
- Lead and implement critical process improvement initiatives to maintain high efficiency in a high-volume environment.
- Provide leadership for both local and offshore teams.
Compensation & Perks:
- Base salary starting at $120,000+ (commensurate with credentials and experience).
- Work in a beautiful new office location featuring walking paths, an on-site cafeteria, and a gym.
Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States.
Job Type: Contract
Pay: From $120,000.00 per year
Application Question(s):
- How many years of prior-authorization experience or related experience in a medical group, IPA or management company do you have?
- Any experience ib project development and implementation?
- How big is the largest team you have been responsible for?
- In terms of production, what is the highest volume of inventory you have overseen per month?
- Any experience in employee development and mentoring?
Work Location: In person
