Vice President, Utilization Management

About the role

This senior leader will oversee utilization management strategy and execution, with a focus on aligning clinical operations to organizational goals and health benefit performance. The role will partner closely with cross-functional teams to strengthen decision-making, improve service quality, and drive measurable outcomes across the business.

Responsibilities

• Plan and execute utilization programs to meet health benefit ratio targets
• Collaborate across teams to enhance utilization management strategies
• Lead data-driven decision-making processes to improve outcomes
• Identify and implement innovative solutions for greater efficiency in utilization management
• Establish standard operating procedures to support consistent quality and service results
• Design processes to uncover opportunities for cost reduction and outcome improvement
• Develop and implement revised operational models in response to healthcare trends

Qualifications

• Bachelor's Degree in Nursing or a related healthcare field required; Master's Degree preferred
• 10+ years of experience in managed care, health plans, or provider network organizations required
• Current nursing license required; experience with Managed Medicaid preferred
• Demonstrated leadership in cross-functional team settings
• Strong knowledge of compliance and regulatory requirements in utilization management

Benefits

• Comprehensive health benefits package
• Professional development opportunities
• Flexible working arrangements
• Retirement savings plans with company matching
• Supportive organizational culture focused on innovation

Pay

$188,900 – $359,800 annually

Location: Remote - US based candidates only, no visa sponsorship available