Utilization Management & Claims Senior Manager

📋 Description

• Provide strategic oversight of UM and delegated Claims across multiple IPAs, ensuring compliance.
• Lead and mentor a 5–10 person UM/Claims team, setting standards and accountability.
• Serve as primary liaison for contracted health plans: inquiries, reporting, escalations.
• Oversee health plan audits, coordination, accuracy, timely submission.
• Ensure regulatory timelines for authorizations, adjudication, payment, and reporting.
• Monitor KPI metrics: denial rates, timeliness, audits, documentation.

🎯 Requirements

• 10+ years in Utilization Management, Claims, Managed Care or IPA/MSO operations.
• California regulatory UM and delegated claims expertise (preferred).
• Experience leading health plan audits, ODAG logs, and timeliness reporting (preferred).
• Experience managing teams in multi-IPA or delegated risk environments (preferred).
• Authorization workflows, medical necessity criteria, and claims adjudication (preferred).
• On-site in Chino, CA (preferred).

🎁 Benefits

• Stock options package
• Medical, dental and vision coverage
• 401K
• Long-term disability
• Unlimited PTO
• Life insurance
• Paid Leave Program