Utilization Management (UM) Program Manager

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Utilization Management (UM) Program Manager
General Information

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Work Location: Los Angeles, CA, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday-Friday, 8:00am-5:00pm PST, weekend and holiday coverage as needed
Posted Date
04/03/2026
Salary Range: $70900 - 145200 Annually
Employment Type
2 - Staff: Career
Duration
indefinite
Job #
29613
Primary Duties and Responsibilities

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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
Job Qualifications

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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

As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
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