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The Utilization Management (UM) Program Manager plays a vital
role in driving the strategic planning, execution, and continuous enhancement
of UM programs. The position ensures the delivery of clinically appropriate and
cost-effective care by optimizing utilization management processes across the
organization.
Key Responsibilities:
Lead and manage UM programs to align with organizational
goals for quality, efficiency, and compliance.
Collaborate closely with clinical UM, Care
Management, Quality, Information Technology (IT), and other key stakeholders,
to streamline authorization workflows and improve operational efficiency
Develop and implement strategies to reduce avoidable
denials and enhance patient throughput
Ensure adherence to regulatory and accreditation
standards through Effective program oversight and compliance monitoring
Coordinate complex, multi work stream
initiatives that involve cross functional teams
Utilize data analytics to inform decision
making, identify opportunities for improvement, and measure program outcomes
Standardize UM processes, tools, and
documentation to promote consistency and scalability
Facilitate communication and change management
efforts to support successful program adoption and sustainability
Support other clinical departments as needed to advance organizational objectives
Salary Range: $70,900-$145,200/annually
Qualifications
Required:
Bachelor’s
degree in healthcare administration, business, public health, or a related field
and/or equivalent experience
5+ years
of related experience or training in healthcare operations, utilization
management, care management, quality, revenue cycle, contracting, or related
operational/program work
3+ years of experience leading cross functional
projects or programs that include workflow improvement, stakeholder
coordination, and measurable outcomes (may be included within the 5+ years)
Strong analytical skills to define metrics,
interpret trends, and translate findings into action plans
Ability to communicate clearly in writing and
verbally with clinicians, administrators, and technical partners
Facilitate work groups and meetings effectively
including agendas, decision capture, and follow up tracking
Uses sound judgment to prioritize work, manage competing
deadlines and raise risks early
Ability to build collaborative relationships
across departments and supports constructive resolution of workflow issues
Designs scalable workflows, documentation, and
controls that support consistent operations and sustainment
Maintains discretion and protects sensitive
information learned through work activities
Preferred
Master’s degree (MPH, MHA, MSN, MBA) or equivalent
advanced training
Demonstrates working knowledge of UM workflows
such as prior authorization, concurrent review, and denials/appeal.
Uses UM tools and reporting methods (e.g. InterQual/MCG, authorization platforms, self-service
reporting) to support outcomes
At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.