Director of Care & Utilization Management

Maine Community Health Options; Maine; Hybrid; USD 133,000 - 154,000; Full time

Benefits offered by this job

Competitive cash compensation

Generous PTO

401(k) match

Job summary

Community Health Options seeks a Medical Management Director to lead care management, utilization management, and appeals programs. This role requires strategic vision, strong leadership, and a focus on high‑quality, cost‑effective care in compliance with regulations.

Under the CMO, you will develop plans, mentor a team, manage budgets, monitor performance, and drive continuous improvements across population health initiatives, while collaborating with senior leaders to align goals with the

Qualifications

• Bachelor’s degree in a related health field is preferred.
• 2-3 years of Health Plan medical management experience (utilization management and appeals).
• Leadership experience with human resource principles and regulatory adherence.

Responsibilities

• Develop and implement strategic plans for care management, utilization management, and appeals programs.
• Lead and mentor a team of professionals in these areas, fostering excellence and continuous improvement.
• Collaborate with senior leadership to align departmental goals with the organization’s mission and objectives.
• Under the oversight of the CMO, manage budgets for programs and care models.
• Oversee the appeals process to ensure timely handling of denials and appeals.

Skills

Strategic leadership

Care management

Utilization management

Appeals process

Regulatory compliance

Education

Bachelor's degree in health field

Tools

Microsoft Office Suite

Job description

Community Health Options seeks a Medical Management Director to lead care management, utilization management, and appeals programs. This role requires strategic vision, strong leadership, and a focus on high‑quality, cost‑effective care in compliance with regulations.

Under the CMO, you will develop plans, mentor a team, manage budgets, monitor performance, and drive continuous improvements across population health initiatives, while collaborating with senior leaders to align goals with the