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Director Utilization Management Jobs in California

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What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What is a Director Utilization Management job?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a Director Utilization Management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

What are the most commonly searched types of Utilization Management jobs in California? The most popular types of Utilization Management jobs in California are:
What are popular job titles related to Director Utilization Management jobs in California? For Director Utilization Management jobs in California, the most frequently searched job titles are:
What job categories do people searching Director Utilization Management jobs in California look for? The top searched job categories for Director Utilization Management jobs in California are:
What cities in California are hiring for Director Utilization Management jobs? Cities in California with the most Director Utilization Management job openings:
Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in California as of June 2026, with employment types broken down into 82% Full Time, 15% Part Time, and 3% Temporary. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Director, Utilization Management

Alameda Health System

Oakland, CA

Full-time

Medical, Retirement, PTO

Re-posted 5 hours ago

Alameda Health System rating

8.3

Company rating: 8.3 out of 10

Based on 16 frontline employees who took The Breakroom Quiz

Job description

Summary

  • 100% employer health plan for employees and their eligible dependents
  • Unique benefit offerings that are partially or 100% employer-paid
  • Rich and varied retirement plans and the ability to participate in multiple plans.
  • Generous paid time off plans

Role Overview:

Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 

  • Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. 
  • Monitor and evaluate the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. 
  • Analyze data and generate reports on utilization trends, outcomes and quality indicators to support decision-making and process improvement initiatives. Reports to appropriate committees. 
  • Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations. Evaluate utilization reviews and determine program improvements.  
  • Develop and implement utilization review policies and procedures in accordance with industry standards and regulatory requirements.  
  • Direct and coordinate data gathering and record keeping legally required by federal and state agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects 
  • Foster effective communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process. 
  • Participate in interdisciplinary committees and meetings to contribute to the development and implementation of quality improvement initiatives.  
  • Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals. Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding UM matters. 
  • Perform all other duties as assigned. 
  • Prepares cost analysis reports and other data needed for the preparation of the departmental budget. 
  • Provides in-house educational programs as needed for both staff and physicians. 
  • Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. 
  • Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession.

MINIMUM QUALIFICATIONS:

Required Education: Bachelor’s degree in Nursing

Preferred Education: Master’s degree in Nursing 

Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.

Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.

Preferred Licenses/Certifications: UM / CM certifications


Highland General Hospital
SYS Utilization Management
Full Time
Day
Nursing
FTE: 1

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