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Director of Utilization Management

2 months ago

Crown Point, United States Vaco Full time

Job Summary

We are seeking an experienced and dynamic Director of Utilization Management to lead and oversee the utilization management (UM) program for our health plan. The Director of Utilization Management will be responsible for developing and implementing UM strategies, ensuring efficient and effective use of healthcare resources, and maintaining compliance with regulatory standards. The ideal candidate will have a strong clinical background, exceptional leadership skills, and a deep understanding of utilization management principles.

Key Responsibilities

  • Program Development and Management
  • Clinical Oversight
  • Data Analysis and Reporting
  • Regulatory Compliance
  • Team Leadership and Development
  • Collaboration and Communication

Qualifications

  • Bachelor's degree in Nursing, Healthcare Administration, or a related field; Master's degree preferred.
  • Active RN license required; other clinical licenses (e.g., LCSW, PharmD) may be considered based on experience.
  • Minimum of 7 years of experience in utilization management, with at least 3 years in a leadership role.
  • Strong knowledge of UM principles, healthcare regulations, and accreditation standards.
  • Excellent analytical, problem-solving, and decision-making skills.
  • Exceptional communication and interpersonal skills.
  • Proficiency in UM software and tools.
  • Certification in case management (CCM) or utilization management (CPHM) is a plus.

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