Director of Utilization & Care Optimization

Bradford Health Services; United States; On-site; USD 130,000 - 170,000; Full time

Benefits offered by this job

Medical Coverage

Mental Health Support

Student Loan Repayment

Generous PTO

Job summary

A healthcare provider in the United States is seeking a Director of Utilization Review to oversee utilization management processes. This leadership role involves developing strategies to optimize resource use and ensure compliance with regulatory standards. The ideal candidate will have a Bachelor’s degree in Nursing or a related field, at least five years of relevant experience, and strong analytical skills. Competitive benefits package and commitment to employee support included.

Qualifications

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field.
• Minimum of 5 years of progressive experience in utilization review or healthcare operations.
• Strong knowledge of healthcare regulations, payer policies, and accreditation standards.

Responsibilities

• Lead and manage the utilization review department to ensure compliance.
• Develop policies and procedures for utilization management practices.
• Collaborate with clinical teams and payers for care delivery.

Skills

Leadership

Clinical data analysis

Communication

Healthcare regulation knowledge

Data analytics

Education

Bachelor’s degree in Nursing or related field

Master’s degree in Nursing or related field

Tools

Healthcare data analytics tools

Electronic health record (EHR) systems

Job description

A healthcare provider in the United States is seeking a Director of Utilization Review to oversee utilization management processes. This leadership role involves developing strategies to optimize resource use and ensure compliance with regulatory standards. The ideal candidate will have a Bachelor’s degree in Nursing or a related field, at least five years of relevant experience, and strong analytical skills. Competitive benefits package and commitment to employee support included.