Director, Utilization Management Operations

Responsibilities

• Provide leadership and development for clinical and non-clinical teams
• Manage a team of Senior Managers overseeing nurses and coordinators
• Oversee offshore vendor partnerships to meet performance metrics
• Evaluate and prioritize improvements in technology and AI tools
• Develop and monitor KPIs for operational health and decision accuracy
• Collaborate with Compliance teams to maintain audit readiness
• Partner with Provider Network team to enhance operational responsiveness

Qualifications

• Experience leading large clinical teams in healthcare settings
• Proven ability to transform complex operational challenges into efficient processes
• Data-driven mindset with experience in AI tools for workflow optimization
• Strong ethical standards with a deep understanding of regulatory guidance
• Exceptional communication skills to relay complex information clearly

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above
• Parental leave program
• 401K program