Director of Care Management & Utilization

ScionHealth; Los Angeles (CA); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Sign-on bonus

Short term incentive plan

Job summary

ScionHealth’s Los Angeles hospital seeks a Director of Case Management and Utilization Management to lead care coordination and discharge planning, while driving a strong focus on outcomes and resource use. The role involves overseeing denial management and ensuring regulatory compliance, in partnership with executive leadership.

The position requires RN licensure or equivalent, a clinical degree, and several years of hospital case management experience, with leadership responsibilities

Qualifications

• Bachelor’s Degree in a clinical field (Required).
• Bachelor’s Degree in Nursing (Preferred).
• Equivalent combination of education and experience (May be considered).

Responsibilities

• Direct Case Management and Utilization Management activities.
• Oversee the coordination of care for patients and families.
• Ensure quality outcomes and efficient resource utilization.
• Partner with external customers, referral sources, and payors.
• Serve as a patient and family advocate.
• Accountable for the facility’s denial management program.
• Ensure compliance with regulatory requirements.
• Collaborate with hospital executive leadership.

Skills

RN License/State Licensure

Leadership experience

Managed care knowledge

Case management experience

Education

Bachelor’s Degree in a clinical field

Bachelor’s Degree in Nursing

Equivalent combination of education and experience

Job description

ScionHealth’s Los Angeles hospital seeks a Director of Case Management and Utilization Management to lead care coordination and discharge planning, while driving a strong focus on outcomes and resource use. The role involves overseeing denial management and ensuring regulatory compliance, in partnership with executive leadership.

The position requires RN licensure or equivalent, a clinical degree, and several years of hospital case management experience, with leadership responsibilities