Director, Commercial Utilization Management

Your Role

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

This role requires weekly travel to an approved BSC office, and monthly travel to the Rancho Cordova BSC office. Ad hoc travel as needed.

Your Knowledge and Experience

• Requires current CA RN License
• Bachelors of Science in Nursing or advanced degree preferred
• Master's degree or equivalent experience preferred
• Minimum of 10 years prior relevant experience, including 6 years of management experience
• Minimum of 5 years of progressive leadership in Utilization Management operations, preferred
• 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