Director of Utilization Management

Director of Utilization Management (RN)- Hybrid

Remote/Hybrid – 2 days per week in the office

A growing healthcare organization is seeking an experienced Director of Utilization Management to lead its Medicare UM department.

This is an exciting opportunity for a hands-on leader to oversee and develop the UM function as the department continues to expand.

Key Responsibilities:

• Lead day-to-day Utilization Management operations
• Oversee utilization review, case management, and precertification functions
• Develop and implement UM policies, procedures, and workflows
• Ensure compliance with CMS, Medicare, and applicable regulatory guidelines
• Monitor utilization trends, reporting, and department performance
• Lead, develop, and train the UM team

Qualifications:

• Active RN license
• Strong leadership experience in Utilization Management
• Direct Medicare Utilization Management experience is required
• Knowledge of CMS guidelines, InterQual, and Medicare regulations
• Experience managing teams and improving UM processes

Interested candidates or referrals are encouraged to reach out for additional details!

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