Director of Utilization Management & Referrals

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

Job summary

Palm Medical Centers in Florida seeks a Director of Utilization Management to oversee the Referrals Department and RN Case Managers across our network of primary care clinics. This leadership role ensures efficient use of resources, regulatory compliance, and high-quality patient care.

The director will lead strategic referral optimization, manage a multidisciplinary team, develop policies, monitor utilization, and collaborate with external partners to streamline care transitions.

Qualifications

• RN BSN with a valid multistate license; master's degree in nursing, public health, or related field.
• Minimum 10 years of healthcare administration experience with at least 5 years in leadership in utilization management or case management.
• Experience in a primary care network is highly preferred.
• Proven track record in managing referrals, case management teams, and resource optimization.

Responsibilities

• Direct day-to-day operations of the Referrals Department and RN Case Managers.
• Provide strategic leadership in optimizing patient referrals, case management, and resource utilization.
• Manage and mentor clinical and administrative staff.
• Develop and implement policies for referral management and care coordination.
• Oversee utilization review processes and adherence to guidelines.
• Monitor referral patterns and outcomes; analyze trends.
• Ensure regulatory and accreditation standards are met.
• Collaborate with external partners to facilitate care transitions.
• Report to senior leadership on utilization trends and improvements.
• Identify opportunities to reduce unnecessary utilization and costs.
• Lead audits and quality improvement initiatives.
• Travel to various center locations.

Skills

Leadership

Utilization management

Team building

Data analysis

EHR proficiency

Education

RN BSN with multistate license

Master's degree in nursing or public health

Tools

EHR systems

Job description

Palm Medical Centers in Florida seeks a Director of Utilization Management to oversee the Referrals Department and RN Case Managers across our network of primary care clinics. This leadership role ensures efficient use of resources, regulatory compliance, and high-quality patient care.

The director will lead strategic referral optimization, manage a multidisciplinary team, develop policies, monitor utilization, and collaborate with external partners to streamline care transitions.