Supervisor, Utilization Management

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.

About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Supervisor, Utilization Management will be a content expert and resource for all clinical data and criteria used for prior authorization. The supervisor role will lead the Utilization Management team in ongoing training, ensuring regulatory requirements are being met, and driving team engagement. Under direction of the Director, Medical Management, assists in short and long-range program planning, process improvement, and management of the Clinical Services division. Provides analysis and reporting on clinical performance. Prepares department for internal and external audits; conducts utilization management delegation audits and develops policies and procedures for adherence to governmental and accredited agency standard. The successful candidate will oversee and participate in the development and implementation of effective and efficient standards, policies, protocols, processes, reports and benchmarks that support and further enhance utilization management and timely access to care the support the strategic mission of Altais.

Supervises and coordinates activities of utilization review staff in maintenance of informed policy and procedure manuals, files, records and correspondence. Provide guidance on issues related to referral and authorization process, benefits interpretation, and other utilization issues. Provide Clinical Oversight for the Utilization Management Functions by evaluating effectiveness and determining the efficiency of ongoing projects in the workplace. Provide medical direction and drives quality and process improvement efforts for the functions and activities related to the authorization of eligible medical services, referral authorization activities, and referral authorization staff. Facilitates recruitment, selection, orientation and staff training, coaching and development. Communication of staff performance and conducts annual performance evaluations. Advising and coaching team members by providing guidance on operational/project issues, key success factors of the project, and lessons learned. Set clear expectations for team members, including defining what they should do on a daily and project level basis. Actively engages with the Management Leadership Team to define and measure goals for organizational/departmental performance and determines/develops the tasks and resources needed to attain them. Lead and directs the development, implementation, and evaluation of care management programs, policies and procedures and programs as part of annual strategic initiatives and reporting. Manage internal and external stakeholder relationships and partnering with different departments as needed to work cross functionally and deliver on the initiatives. Work closely with the stakeholders to establish priorities, areas of concern and implementation plan. Establish technical/stakeholder forums as required to brainstorm, resolve and provide transparency on issues proactively Manage and/or lead project role assignments, prioritizing, and communicating to the team and stakeholders proactively. Escalating regularly on project/operational issues as needed. Manages relationship and communication external stakeholders and health plans.