Director, Utilization Management Operations
Core
Lead Utilization Management operations to ensure members receive the right care at the right time by bridging clinical needs with scalable business processes.
Role type
Director of Utilization Management Operations
Builds
Scalable utilization management processes and AI-enabled clinical workflows
Domain
US Healthcare / Utilization Management
Deliverable
production ML models | dashboards & analysis | client delivery
Required skills
Clinical team leadership, operational transformation, data-driven decision making, regulatory compliance, stakeholder collaboration
Preferred skills
Utilization Management process expertise, Medicare Advantage operations knowledge, MBA or advanced degree in health administration
Technologies
Internal technology platform, AI tools
Responsibilities
Lead clinical and non-clinical teams and offshore vendor partnerships, evaluate technology improvement opportunities, develop and monitor KPIs, ensure regulatory compliance with Medicare guidelines, partner with provider networks and medical directors
Seniority
Director, strategic leadership & team management