Outpatient Utilization Management Lead, Senior Manager

Alameda Alliance; Alameda (CA); On-site; USD 143,000 - 215,000; Full time

Job summary

Alameda Alliance seeks a Senior Manager, Outpatient Utilization Management to lead the UM team under the Director of Health Care Services. The role directs policy development, program implementation, and care coordination to optimize outcomes and cost effectiveness for members.

Responsibilities include mentoring staff, maintaining regulatory compliance, and producing meaningful reports while collaborating across departments for organizational goals.

Qualifications

• BSN or MSN required and active RN license in California.
• Administrative Master’s degree preferred.
• Knowledge of Medi-Cal/Medicare regulations and accreditation standards preferred.
• TB test clearance prior to/hire and CPR/First Aid preferred.

Responsibilities

• Oversee outpatient utilization management and care coordination.
• Lead and mentor the UM team and ensure policy and program development.
• Develop and monitor authorizations, productivity metrics and reports.
• Ensure regulatory, contractual and accreditation compliance (CMS, DHCS, DMHC, NCQA).
• Collaborate with department leadership to align goals with organizational strategy.
• Recruit, train, and evaluate staff and manage performance.

Skills

Leadership

Project management

Healthcare regulations

Communication

Mentoring

Education

BSN or MSN

RN license

Administrative master’s

TB test clearance

CPR & First Aid

Certification

Job description

Alameda Alliance seeks a Senior Manager, Outpatient Utilization Management to lead the UM team under the Director of Health Care Services. The role directs policy development, program implementation, and care coordination to optimize outcomes and cost effectiveness for members.

Responsibilities include mentoring staff, maintaining regulatory compliance, and producing meaningful reports while collaborating across departments for organizational goals.