Director of Utilization Management & Clinical Operations

Evolving Solution Services; California (MO); On-site; USD 200,000 - 235,000; Full time

Benefits offered by this job

Health, life, dental, and vision insurance

403(b) with company match

Innovative work culture

Job summary

Evolving Solution Services in California is seeking a Utilization Management Director to build and lead the first internal clinical utilization management function. This role involves establishing processes, policies, and team structure while partnering closely with various departments for an efficient utilization management program. The ideal candidate will have extensive experience in utilization management, healthcare operations and possess strong leadership skills. Competitive salary ranging from $200,000 to $235,000 annually with benefits including health insurance.

Qualifications

• Must be a licensed clinical professional with strong utilization management experience.
• Demonstrated experience managing departmental budgets and clinical teams.
• Strong knowledge of utilization management functions and healthcare regulations.

Responsibilities

• Develop and launch internal Utilization Management and Clinical Operations function.
• Build and lead a clinical team focused on quality assurance processes.
• Collaborate with other departments to streamline clinical review processes.

Skills

Utilization management experience

Leadership experience

Analytical skills

Communication skills

Knowledge of healthcare regulations

Education

Bachelor’s degree in Nursing or Healthcare Administration

Tools

Salesforce-based clinical case management platform

Job description

Evolving Solution Services in California is seeking a Utilization Management Director to build and lead the first internal clinical utilization management function. This role involves establishing processes, policies, and team structure while partnering closely with various departments for an efficient utilization management program. The ideal candidate will have extensive experience in utilization management, healthcare operations and possess strong leadership skills. Competitive salary ranging from $200,000 to $235,000 annually with benefits including health insurance.