Director, Utilization Management

This is a fully remote position, open to applicants in Florida.

📋 Description

• Direct the utilization management team to ensure the appropriate application of policies and processes for optimal member outcomes.

• Supervise daily operations of Utilization Management, focusing on timeliness, quality, performance results, provider interactions and experiences, as well as regulatory and compliance measures.

• Drive team performance, facilitate improvements, and consider career development opportunities.

• Ensure that utilization management policies and procedures adhere to corporate, state, and NCQA standards.

• Evaluate, analyze, and report on utilization trends, patterns, and their impacts.

• Spearhead process enhancements and present findings to senior leadership.

• Establish effective policies and procedures for conducting utilization reviews.

• Formulate utilization management strategies and provide recommendations that align with the organization's objectives.

• Oversee departmental budget components and collaborate with senior leadership.

• Guide onboarding, recruitment, and training strategies for new team members.

• Lead and manage teams in a matrixed and cross-functional environment.

• Advocate for change and perform other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must reside in Florida.

• Bachelor's degree with at least 7 years of relevant experience, including prior management experience, or equivalent expertise gained through applicable knowledge, responsibilities, and skills.

• Preferred 4+ years of management experience.

• Strong foundation in Long-Term Care (LTC) Utilization Management.

• Experience with Medicaid managed care, LTSS/LTC, prior authorization, and care management operations.

• Preferred expert knowledge of industry regulations, policies, and standards.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off, in addition to holidays.

• Flexible working arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in the overall compensation package.

• Equal opportunity employer dedicated to promoting diversity.