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Utilization Management (UM) Program Manager

UCLA Health • Los Angeles, CA • 9h ago

DescriptionThe 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/annuallyQualifications

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

UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.

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