Director – WTS

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

📋 Description

• Collaborate with leadership to outline and implement the product strategy for Utilization Management solutions.

• Oversee the definition of products and features, converting business, clinical, and regulatory demands into product concepts and specifications.

• Create and sustain product roadmaps for new functionalities and enhancements to existing systems.

• Recognize opportunities to enhance utilization review processes, cost management, compliance, and user experience.

• Formulate business cases for new products and significant enhancements, incorporating ROI, cost-benefit analysis, and operational impact.

• Measure expected improvements in utilization efficiency, turnaround times, cost savings, and quality outcomes.

• Deliver recommendations and investment rationales to senior leadership.

• Collaborate with finance, operations, and clinical teams to verify assumptions and track realized value.

• Spearhead product initiatives from conception through to delivery and post-launch optimization.

• Generate comprehensive requirements for development teams.

• Assess technologies that enhance HealthHelp’s competitive edge.

• Prioritize the backlog based on business value, regulatory needs, and user impact.

• Work alongside IT, clinical, operations, and compliance teams to ensure successful delivery.

• Evaluate UM platforms, workflows, and capabilities to pinpoint gaps and opportunities for enhancement.

• Lead advancements in automation, scalability, usability, and compliance.

• Promote ongoing improvement of the UM program's performance through product innovation and optimization.

• Define, monitor, and report on KPIs, including turnaround time, denial/approval accuracy, cost containment, and user adoption.

• Utilize data insights and stakeholder feedback to identify performance discrepancies and implement targeted solutions.

• Act as a liaison across product, clinical, operations, IT, compliance, and executive stakeholders.

• Facilitate consensus on priorities, timelines, and success metrics.

• Support change management, training, and the adoption of new features and enhancements.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business, Technology, or a related field.

• 5–8+ years of experience in product management, utilization management, or healthcare operations.

• In-depth knowledge of UM processes (prior authorization, concurrent review, medical necessity review).

• Experience in developing business cases and leading product/feature definitions.

• Proven capability to manage complex, cross-functional initiatives.

• Strong analytical and problem-solving abilities.

• Preferred experience with UM platforms, care management systems, or health IT solutions.

• Familiarity with regulatory frameworks such as CMS, NCQA, and URAC is preferred.

• Experience in Agile or hybrid product environments is preferred.

• Clinical background (e.g., RN, LPN) or equivalent experience is preferred.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Paid time off (PTO), holidays, and sick leave.

• 401(k) with company match or other retirement plans.

• Life and AD&D Insurance.

• Employee Assistance Program.

• Performance-based bonuses, incentive pay, or commissions may be available.