Our client is seeking an experienced and dynamic Utilization Management (UM) Director to lead the strategic vision for the UM service line for the next 2-3 years. This individual will be accountable for the success of the clients UM program, providing direction and oversight for all UM initiatives, and acting as the company’s subject matter expert in UM. The ideal candidate is a strong collaborator with exceptional stakeholder management skills, highly organized, and a self-starter.

Compensation : Competitive base salary ranging from $145,810 - $175,000 + equity, benefits, and leadership bonus potential.

Key Responsibilities:

• Lead and oversee the clients UM program, ensuring its overall success.
• Manage the UM program, with dotted line oversight of the UM RN lead.
• Coordinate with both internal and external resources to develop, implement, and execute the UM program.
• Establish and maintain strong relationships with key cross-functional stakeholders.
• Ensure internal and external workflows are efficient, effective, and up-to-date.
• Collaborate closely with Care and Case Management (CCM) and member care operations to enhance member experience in UM operations.
• Serve as the final escalation point for workflow questions, clarifications, and complex cases.
• Continuously focus on improvement by piloting solutions that boost team productivity, workflows, member experience, and operational efficiency.
• Design and implement a quality review process for both internal and external UM operations.
• Adapt and evolve responsibilities as needed based on CCM and/or UM program demands.

Basic Qualifications:

• Bachelor’s Degree required.
• Master’s Degree in Nursing, Hospital Administration, or related field required.
• Registered Nurse (RN) in good standing, with a minimum of 3 years of inpatient RN experience.
• At least 5 years of management experience in a health-related field and 3 years in a quality management role.
• Proven experience in quality and workflow management.
• Exceptional organizational skills and attention to detail.
• Data-driven, with the ability to evaluate and optimize care standardization across the team.
• Comfortable balancing multiple priorities in a fast-paced, dynamic environment.
• Strong communication skills, both verbal and written.
• Highly motivated with a strong internal drive.