Director of Utilization Management

📋 Description

• Lead strategy and operations for utilization management programs.
• Oversee prior authorizations and appeals reviews.
• Develop and maintain review plans, policies, workflows.
• Collaborate with medical leadership on criteria and decisions.
• Drive quality improvement, audits, and reliability testing.
• Align programs with regulatory and client objectives.

🎯 Requirements

• Bachelor’s degree in a relevant field preferred.
• 10+ years in utilization management leadership in managed care.
• Experience managing clinical and non-clinical teams.
• Knowledge of NCQA or URAC accreditation requirements.
• Strong analytical skills to review records and trends.
• Experience creating policies and operational frameworks.

🎁 Benefits

• Competitive annual compensation of $160,000.
• Annual bonus program opportunities.
• Remote work flexibility.
• Medical, dental, and vision insurance coverage.
• 401(k) retirement plan with company match.
• Paid time off and holidays.