Utilization Review Director

  • Compensation: $140,000.00 - $170,000.00 per year
  • Required Qualifications:
  • City/State: Pasadena, CA

AMI Network is partnered with a large healthplan organization to find their next Utilization Management Director in Pasadena.

Our client is a leading Health Plan + IPA that offers full-service Medicare Advantage coverage across multiple counties in California, currently serving over 60k+ members from major Health Plans like Anthem, SCAN, and Alignment Health.

As the Utilization Review Director, you'll oversee 4 direct reports on the IPA side (UM supervisors + coordinator), and play a crucial role in providing operational leadership to the UM/Prior Authorization and Inpatient Teams (50 FTEs in total). You’ll be responsible for CMS + Health Plan audits, and ensuring compliance with Federal, State, Health Plan, and NCQA requirements.

This role offers a competitive salary in the ballpark of $165k (give or take based on experience) -Plus great benefits: 3 weeks PTO, 8 Holidays, 401k + matching, HMO or PPO Medical/Dental, vision, and life insurance.

APPLY NOW if you're interested in taking the next big step in your career!