Director, Utilization Review and Social Worker Services

CHA Hollywood Presbyterian Medical Center

. Direct overall hospital utilization management, transition management, and operational management of the Case Management Department .

Posted 10/23/2026full-timeLos Angeles • California • United StatesLead💰 $200,000 - $235,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in hospital utilization management, operational management, and compliance with CMS regulations. Proficient in leading case management initiatives, providing physician education, and managing behavioral health resources.

Highest-signal resume keywords

Hospital Utilization ManagementAcute Hospital Case ManagementRegistered Nurse LicenseLeadership ExperienceCritical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Revenue Cycle ManagementData-Driven Performance ImprovementMedical Necessity CompliancePatient Transition PlanningBehavioral Health CoordinationOrganizational SkillsComputer LiteracyPayer Dispute PreventionHealthcare Regulations ComplianceSocial Work Interventions

Soft Skills

Effective CommunicationProblem SolvingTeam CoordinationEducation and Feedback DeliveryOrganizational Skills

Certifications & Qualifications

LCSW LicenseLMSW LicenseLos Angeles County Fire & Safety CardAssault Response Competency (ARC)Accredited Case Manager (ACM)

Industry Keywords

Healthcare AdministrationPatient ThroughputRegulatory ComplianceTJC Accreditation StandardsUnion Environment

About the role

Key responsibilities & impact

Direct overall hospital utilization management, transition management, and operational management of the Case Management Department
Promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and regulatory compliance
Lead implementation and oversight of the hospital Utilization Management Plan using data to drive performance improvement
Ensure medical necessity and revenue cycle processes comply with CMS regulations and HPMC policy
Ensure timely and effective patient transition and planning
Implement and monitor processes to prevent payer disputes
Develop and provide physician education and feedback on hospital utilization
Participate in management of the post-acute provider network
Ensure compliance with state and federal regulations and TJC accreditation standards
Provide education to physicians, patients, families, and caregivers
Manage department operations to support throughput and reimbursement
Utilize community, government, and client resources to address participant limitations and chronic-condition needs
Manage behavioral and psychosocial needs and deliver social work interventions
Assist members in using resources and developing self-management capabilities
Evaluate psychosocial needs, strengths, and ability to manage healthcare independently
Facilitate and coordinate behavioral health resources
Collaborate with the Vice President of Revenue Cycle on finance matters
May provide leadership to the Health Information Management Team at the direction of the COO
Perform other duties as assigned

Requirements

What you’ll need

Bachelor degree in Business, Nursing or Health Care Administration for RN, or Master's in Social Work for MSW
Registered Nurse or LCSW/LMSW license
Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy
Active RN or LCSW/LMSW license
3 years of acute hospital case management or healthcare leadership experience
Ability to communicate effectively verbally and in writing
Must be able to work in a union environment
Demonstrated organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people in a fast paced environment
Critical thinking and problem solving skills
Computer literacy
Los Angeles County Fire & Safety Card required within 30 days of hire
Assault Response Competency (ARC) required within 30 days of hire
Preferred: MSN, MBA, MSW or MHA; Accredited Case Manager (ACM); 5 years of acute hospital case management leadership multi-site experience; business planning experience