Director, Utilization Management
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Job Description
Director overseeing utilization management team for a healthcare organization, ensuring compliance and improving member outcomes. Leading performance improvements and managing daily operations across multiple locations.
Responsibilities:
- Directs the utilization management team
- Oversees and manages Utilization Operations
- Reviews, analyzes, and reports on utilization trends
- Leads process improvements for the utilization management team
- Establishes policies and procedures for effective utilization reviews
- Develops utilization management strategies
- Responsible for department’s budget components
- Executes onboarding, hiring, and training for new team members
- Leads and champions change within scope of responsibility
Requirements:
- Requires a Bachelor's degree
- 7+ years of related experience
- 4+ years management experience preferred
- RN/Clinical Licensure preferred
- Expert knowledge of industry regulations, policies, and standards preferred
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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