Director, UM & Inpatient Nursing Leadership

Imperial Health Plan; Pasadena (CA); On-site; USD 150,000 - 170,000; Full time

Job summary

Imperial Health Plan in Pasadena, CA seeks a Director of UM - RN to lead the UM/Prior Authorization and Inpatient Teams. This exempt, full-time role reports to the Chief Medical Officer and ensures compliance with regulatory and NCQA standards.

Responsibilities include staff leadership, training, audits, and collaboration across clinical and non-clinical teams to optimize care delivery and adherence to policies.

Qualifications

• Bachelor’s degree in health care related field.
• 5+ years of management experience in medical group, MSO, hospital or health plan.
• 5 years of UM/Managed Care experience.

Responsibilities

• Lead UM/Prior Authorization and Inpatient Teams to comply with federal, state, health plan and NCQA requirements.
• Assign schedules, delegate reviews and ensure staff meet performance goals and policies.
• Ensure UM team conducts medical necessity reviews and documents thoroughly.
• Maintain compliant medical management documentation and criteria used.
• Monitor referral patterns and report to leadership, improving processes.
• Serve as SME on clinical criteria (NCD, LCD, NCCN, MCG).
• Conduct inpatient huddles and annual IRR reviews for clinical and non-clinical staff.
• Prepare and participate in UM audits and workplans.
• Collaborate across disciplines and maintain HIPAA compliance.

Skills

Communication skills

English proficiency

Confidentiality

Customer service

Teamwork

Time management

Regulatory compliance

Education

Bachelor’s degree in healthcare related field

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Imperial Health Plan in Pasadena, CA seeks a Director of UM - RN to lead the UM/Prior Authorization and Inpatient Teams. This exempt, full-time role reports to the Chief Medical Officer and ensures compliance with regulatory and NCQA standards.

Responsibilities include staff leadership, training, audits, and collaboration across clinical and non-clinical teams to optimize care delivery and adherence to policies.