Director of Health Services

Overview

Director of Health Services — Miami, FL. Our client is seeking an experienced, Senior Director (or Executive Director) of Health Services to lead their Health Services department. This role requires a proven track record in Medicare Advantage health plans with strong case management expertise. The successful candidate will oversee a team of 25 professionals involved in case management and concurrent review, ensuring efficient operations, optimizing resources, and maintaining high quality member care. This person must be an RN licensed in Florida to be considered.

Key Responsibilities

• Lead, plan, and manage the Health Services department to maximize productivity and control costs
• Coordinate with providers, members, and internal teams to facilitate optimal care delivery
• Oversee case management and utilization review activities
• Ensure compliance with Medicare Advantage guidelines and standards
• Utilize data analytics to drive performance improvements and operational excellence

Qualifications

• Current, valid Florida Registered Nurse (RN) license required
• Graduate of an accredited School of Nursing
• Minimum 5 years clinical nursing experience
• Minimum 8 years of Utilization Management and/or Case Management experience within a health plan environment
• Minimum 5 years leadership/management experience (not nurse supervisor roles)
• Deep knowledge of utilization review, medical terminology, care levels, treatment modalities, statutes, and healthcare delivery models
• Experience working specifically with Medicare Advantage populations
• Proven organizational skills, time management, and ability to juggle multiple priorities
• Strong data and analytics proficiency

Seniority level

• Director

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care, Public Health, and Health and Human Services