What are the responsibilities and job description for the Utilization Management (UM) Program Manager position at University of California - Los Angeles Health?
Description
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
University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. For the complete University of California nondiscrimination and affirmative action policy, see: UC Nondiscrimination & Affirmative Action Policy.
Salary : $70,900 - $145,200