We are a nationally recognized healthcare management organization with over 40 years of experience delivering innovative, high-quality clinical solutions. Our mission is to improve member health outcomes by identifying risk, promoting treatment compliance, and delivering personalized care.
Position Summary
The Director of Utilization Management & Case Management provides strategic and operational leadership for UM and LCM programs. This role is responsible for driving clinical excellence, regulatory compliance, process improvement, and team performance while partnering with senior leadership, clients, and sales to support continued growth.
Key Responsibilities
- Lead and manage UM and LCM teams, fostering high performance and professional development
- Ensure compliance with URAC standards and applicable state regulations
- Drive process improvement, efficiency, and automation initiatives
- Serve as clinical and operational SME for business development and new product launches
- Collaborate cross-functionally with Sales, Client Services, Clinical, and IT teams
- Support client relationships, reporting reviews, and strategic planning
- Participate in sales presentations and client meetings as needed
Qualifications
- Bachelor’s degree in healthcare, business, or related field
- Clinical background with healthcare leadership experience
- Progressive management experience in healthcare operations
- Experience working with senior leadership and external clients
- Experience in utilization management and case management
- Experience with self-funded groups and InterQual® criteria preferred
- Strong communication, analytical, and leadership skills
- Ability to travel as needed (approximately 10%)
Compensation & Benefits
- Competitive salary based on experience
- Comprehensive benefits package including medical, dental, vision, 401(k), PTO, and more
Join Our Team
If you are a strategic, results-driven healthcare leader ready to make an impact, we invite you to apply.