Utilization Management Director (RN)
Central California Alliance for Health, California, Missouri, United States, 65018
OUR COMMITMENT TO A HUMAN HIRING PROCESS
We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.
SERVICE AREA PREFERENCE
While we encourage all interested applicants to apply, we do give priority to those who live in or near our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.
We have an opportunity to join the Alliance as the Utilization Management Director (RN) leading the Utilization Management Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Leads and shapes the Utilization Management (UM) Strategy for the Alliance while providing management oversight in implementing, directing and monitoring the Utilization Management Department functions, including prior authorizations, concurrent review, medical claims review, appeals and grievance
Directs the Utilization Management Department, acts as a subject matter expert, and provides direction and advice on the Department’s functions and overall business operations
Directs, manages and supervises Utilization Management Department staff
ABOUT US Our mission is to optimize members’ healthcare outcomes through evidence‑based clinical management, stewardship, and collaboration with provider and community partners.
THE IDEAL CANDIDATE
A strong clinical leader
with deep UM expertise who brings sound judgment, regulatory awareness, and a commitment to mission‑driven decision‑making.
Relationship‑centered and impact‑minded , able to balance oversight of the Utilization Management department with a collaborative approach that maintains trust across internal teams and external partners.
Strategic, change‑ready, and operationally adept , guiding teams through evolving priorities, articulating organizational shifts with clarity, and advancing process improvements and cross‑functional projects that strengthen UM operations.
A transparent communicator and mentor , skilled at prioritizing, supporting team growth, modeling accountability, and sustaining momentum while adapting thoughtfully as work evolves.
A bridge‑builder who sees the big picture , collaborating across functions, presenting confidently, and fostering alignment and cohesion in a fast‑moving environment.
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge:
The principles and practices of utilization management
The principles and practices of clinical nursing
Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations
The principles and practices of managed care
UM documentation requirements necessary to satisfy regulatory audits
Ability:
Direct, manage, supervise, mentor, train and evaluate the work of staff
Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
Identify, evaluate, and implement innovations and solutions to optimize, enhance and expand UM programs and activities
Demonstrate a collaborative management style, build rapport, and effectively manage internal and external business relationships including with members of the medical community, community agencies, and board members
Education and Experience:
Current unrestricted license as a Registered Nurse issued by the state of California
Bachelor’s degree in Nursing
A minimum of ten years of utilization management experience which included a minimum of five years of experience in a managed care environment and three years of staff management experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company‑wide events or department meetings will be expected.
In‑office or in‑community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
COMPENSATION INFORMATION
The hiring ranges below represent a good‑faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).
The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas included below. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch.
Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)
Zone 1 (Monterey, San Benito and Santa Cruz)
$213,000 - $245,000 USD
Zone 2 (Mariposa and Merced)
$200,000 - $230,000 USD
OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro‑rated basis for part‑time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations
ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non‑profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E‑Verify participating employer. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full‑time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
U.S. Standard Demographic Questions —
#J-18808-Ljbffr
We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.
SERVICE AREA PREFERENCE
While we encourage all interested applicants to apply, we do give priority to those who live in or near our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.
We have an opportunity to join the Alliance as the Utilization Management Director (RN) leading the Utilization Management Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Leads and shapes the Utilization Management (UM) Strategy for the Alliance while providing management oversight in implementing, directing and monitoring the Utilization Management Department functions, including prior authorizations, concurrent review, medical claims review, appeals and grievance
Directs the Utilization Management Department, acts as a subject matter expert, and provides direction and advice on the Department’s functions and overall business operations
Directs, manages and supervises Utilization Management Department staff
ABOUT US Our mission is to optimize members’ healthcare outcomes through evidence‑based clinical management, stewardship, and collaboration with provider and community partners.
THE IDEAL CANDIDATE
A strong clinical leader
with deep UM expertise who brings sound judgment, regulatory awareness, and a commitment to mission‑driven decision‑making.
Relationship‑centered and impact‑minded , able to balance oversight of the Utilization Management department with a collaborative approach that maintains trust across internal teams and external partners.
Strategic, change‑ready, and operationally adept , guiding teams through evolving priorities, articulating organizational shifts with clarity, and advancing process improvements and cross‑functional projects that strengthen UM operations.
A transparent communicator and mentor , skilled at prioritizing, supporting team growth, modeling accountability, and sustaining momentum while adapting thoughtfully as work evolves.
A bridge‑builder who sees the big picture , collaborating across functions, presenting confidently, and fostering alignment and cohesion in a fast‑moving environment.
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge:
The principles and practices of utilization management
The principles and practices of clinical nursing
Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations
The principles and practices of managed care
UM documentation requirements necessary to satisfy regulatory audits
Ability:
Direct, manage, supervise, mentor, train and evaluate the work of staff
Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
Identify, evaluate, and implement innovations and solutions to optimize, enhance and expand UM programs and activities
Demonstrate a collaborative management style, build rapport, and effectively manage internal and external business relationships including with members of the medical community, community agencies, and board members
Education and Experience:
Current unrestricted license as a Registered Nurse issued by the state of California
Bachelor’s degree in Nursing
A minimum of ten years of utilization management experience which included a minimum of five years of experience in a managed care environment and three years of staff management experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company‑wide events or department meetings will be expected.
In‑office or in‑community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
COMPENSATION INFORMATION
The hiring ranges below represent a good‑faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).
The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas included below. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch.
Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)
Zone 1 (Monterey, San Benito and Santa Cruz)
$213,000 - $245,000 USD
Zone 2 (Mariposa and Merced)
$200,000 - $230,000 USD
OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro‑rated basis for part‑time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations
ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non‑profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E‑Verify participating employer. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full‑time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
U.S. Standard Demographic Questions —
#J-18808-Ljbffr