Director of Utilization & Care Coordination

Palm-Medical-Centers-1; Coral Gables (FL); On-site; USD 150,000 - 210,000; Full time

Job summary

Palm Medical Centers is seeking a Director of Utilization Management to oversee the Referrals Department and RN Case Managers across our primary care clinics. You will align resource use with company standards, regulatory requirements, and quality care practices, driving care coordination and efficiency.

Based in our corporate office with travel to centers, this leadership role requires mentoring staff, developing policies, and overseeing utilization reviews to enhance patient outcomes and

Qualifications

• RN BSN with multistate license; Master's degree in nursing, public health or related field preferred.
• Minimum 10 years in healthcare administration with 5+ years in leadership in utilization/case management.
• Experience in primary care settings or networks of clinics is preferred.

Responsibilities

• Direct day-to-day operations of Referrals Department and RN Case Managers.
• Provide strategic leadership in optimizing referrals, case management, and resource utilization.
• Mentor clinical and administrative staff; foster collaborative, patient-centered care.
• Develop and implement policies for referral management and care coordination.
• Oversee utilization review processes ensuring adherence to guidelines and best practices.
• Monitor referral patterns and outcomes; propose process improvements.
• Ensure compliance with regulatory standards and internal policies.
• Lead audits and quality improvement initiatives related to utilization management.

Skills

Utilization management

Leadership

Data analysis

EHR proficiency

Communication

Education

RN BSN

Master's degree in Nursing/Public Health or related field

Tools

EHR software

Job description

Palm Medical Centers is seeking a Director of Utilization Management to oversee the Referrals Department and RN Case Managers across our primary care clinics. You will align resource use with company standards, regulatory requirements, and quality care practices, driving care coordination and efficiency.

Based in our corporate office with travel to centers, this leadership role requires mentoring staff, developing policies, and overseeing utilization reviews to enhance patient outcomes and