State Licensed Senior Director of Medical Management

Job Summary

A company is looking for a Senior Director, Medical Management.

Key Responsibilities

• Serve as the primary clinical operations expert for utilization management and related workflows
• Collaborate with data science and AI teams to design automated solutions for clinical decision support
• Provide subject matter expertise during product pilots and early implementations

Required Qualifications

• Registered Nurse (RN) with a BSN; MSN or advanced clinical informatics training preferred
• 5-10+ years of experience in utilization management or care management operations
• Experience in health systems or health plans
• Familiarity with clinical documentation review and utilization review processes
• Exposure to health IT or AI-enabled healthcare solutions strongly preferred