Director, Medi-Cal/Medicare Utilization Management Nurse Management

Your Role

Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Director, Medicare & Medi-Cal Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.

Your Knowledge and Experience

• Requires current CA RN License
• Bachelor’s of Science in Nursing or advanced degree preferred
• Master’s degree or equivalent experience preferred
• Minimum of 10 years of Utilization Management or relevant experience, including 6 years of management experience
• Minimum of 5 years of progressive leadership in Utilization Management operations
• Health plan or similar health care organization structure experience required
• Successful track record in driving organizational change management
• Excellent relationship and consensus-building skills required