Director of Utilization Management: Lead Denials & Care Coordination

CommonSpirit Health; Centennial (CO); On-site; USD 150,000 - 210,000; Full time

Job summary

CommonSpirit Health seeks a strategic Utilization Management Director to lead the program across Colorado, Kansas and Utah. You will guide policy development, oversee inpatient and retrospective reviews, and ensure alignment with care coordination goals.

Lead a high-performing team, drive regulatory compliance, analyze utilization data, and partner with physicians and staff to optimize quality outcomes and patient-centered care across the system.

Qualifications

• Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
• 3+ years of clinical case management (Utilization Management, Denial Management, Care Coordination).
• 5+ years of progressively responsible management experience in managed care or hospital operations.
• Comprehensive knowledge of utilization management and revenue cycle requirements.

Responsibilities

• Provide overall direction, design, development, implementation and monitoring of utilization programs to meet Care Coordination goals.
• Ensure compliance with federal/state regulations and internal standards.
• Manage admissions, concurrent and retrospective review processes and denial management.
• Collaborate with leadership to reduce denials and improve value capture.
• Monitor utilization trends and report outcomes to stakeholders.

Skills

Leadership

Healthcare administration

Utilization management

Regulatory compliance

Data analysis

Education

Bachelor's degree in Nursing or Health Care Administration

Master's degree in Nursing or Health Care Administration

Tools

Epic

Cerner

Meditech

Parigon

Job description

CommonSpirit Health seeks a strategic Utilization Management Director to lead the program across Colorado, Kansas and Utah. You will guide policy development, oversee inpatient and retrospective reviews, and ensure alignment with care coordination goals.

Lead a high-performing team, drive regulatory compliance, analyze utilization data, and partner with physicians and staff to optimize quality outcomes and patient-centered care across the system.