Director of Utilization Management

Job Summary

Leading a team of clinicians and coordinators, the full-time Director of Utilization Management will manage operations to ensure timely and accurate utilization management processes, while working remotely and potentially traveling semi-annually for on-site collaboration.

Key responsibilities

• Provide leadership and professional development to clinical and non-clinical teams, fostering a culture of integrity and clinical excellence
• Directly manage Senior Managers and offshore vendor partnerships to align performance metrics with departmental targets
• Collaborate with Data Science and Engineering teams to develop and monitor comprehensive KPIs for operational health and decision accuracy

Required qualifications

• Demonstrated experience leading large clinical teams with an understanding of healthcare workflows
• Proven ability to transform complex operational challenges into scalable business processes
• Data-driven mindset with experience in leveraging AI-enabled tools for clinical workflow optimization
• High ethical standards and mastery of complex regulatory guidance
• Exceptional written and verbal communication skills for distilling complex problems into actionable updates