Qureos Mentor

College Hospital Costa Mesa

Overview A behavioral health facility in California is seeking a dynamic and experienced Director of Case Management to oversee Utilization Review (UR) operations and lead a high-performing interdisciplinary team committed to delivering high-quality, patient-centered care.This is a key leadership role responsible for ensuring effective care coordination, regulatory compliance, and optimal utilization of behavioral health services across inpatient and/or outpatient programs. The ideal candidate brings strong clinical expertise, leadership experience, and a deep understanding of payer requirements and utilization management in behavioral health settings.The Director of Case Management will provide strategic and operational oversight of the Utilization Review department. This role ensures that clinical services are medically necessary, appropriately documented, and aligned with regulatory and payer standards while supporting positive patient outcomes and efficient care delivery.You will collaborate closely with clinical leadership, physicians, nursing teams, and external payers to facilitate timely authorizations, reduce barriers to care, and maintain compliance with all applicable state and federal regulations in California.Responsibilities<ul><li>Lead and manage the Case Management and Utilization Review department, including staffing, training, and performance oversight</li><li>Oversee concurrent and retrospective review processes to ensure medical necessity and appropriate level of care</li><li>Ensure compliance with California state regulations, CMS guidelines, and payer requirements</li><li>Collaborate with clinical teams to support effective discharge planning and continuity of care</li><li>Develop and implement utilization management strategies to improve efficiency and reduce unnecessary lengths of stay</li><li>Monitor key performance indicators (KPIs) including denial rates, authorization turnaround times, and case resolution outcomes</li><li>Serve as a liaison with insurance providers and managed care organizations</li><li>Provide leadership in audit preparedness and documentation integrity</li><li>Support staff development through coaching, education, and performance evaluations</li><li>Participate in interdisciplinary leadership meetings and quality improvement initiatives</li></ul>Qualifications<ul><li>Active California RN license</li><li>Minimum 5+ years of behavioral health case management or utilization review experience</li><li>At least 2&ndash;3 years in a supervisory or director-level leadership role</li><li>Strong knowledge of behavioral health levels of care (e.g., inpatient, PHP, IOP)</li><li>Experience working with commercial insurance, Medi-Cal, and managed care organizations</li><li>Familiarity with utilization review criteria sets preferred</li><li>Excellent communication, leadership, and organizational skills</li><li>Strong analytical skills with the ability to interpret clinical and utilization data</li><li>Experience in acute psychiatric or residential behavioral health settings</li><li>Proven ability to reduce avoidable denials and improve authorization outcomes</li><li>Collaborative leadership style with a focus on team development and accountability</li><li>Commitment to patient advocacy and quality of care</li></ul>Pay: $124,000.00 - $141,440.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul>Work Location: In person

Director, Case Management

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College Hospital Costa Mesa

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Director, Case Management