Director of Utilization Management & Revenue Optimization

20 Northeast Georgia Medical Center, Inc.; United States; On-site; USD 140,000 - 200,000; Full time

Job summary

Northeast Georgia Medical Center, Inc. is seeking a Director of Utilization Management to lead the UM functions, optimize reimbursement, and minimize denials. The role collaborates with hospital leadership, physicians, case management, finance, and compliance to enhance quality reporting and patient outcomes.

The position focuses on improving CMI, patient care transitions, and financial integrity, with a leadership approach that drives strategic initiatives and KPI tracking across the department.

Qualifications

• Registered Nurse licensure with UR certification preferred.
• Bachelor's degree required.
• Minimum 7 years UR experience with 2+ years of revenue cycle leadership.

Responsibilities

• Oversee day‑to‑day operations of the Utilization Management Department with payer requirements and regulatory standards.
• Collaborate with case management, managed care, and patient financial services to streamline utilization review.
• Monitor KPIs, LOS, and financial goals to drive performance improvements.
• Recruit, train, and manage a high‑performing UM team and ensure alignment with hospital objectives.
• Manage departmental budgets and resource allocation with financial responsibility.
• Develop and implement metrics to evaluate team effectiveness and drive improvement.
• Foster relationships with hospital executives, physicians, and payers for UM optimization.
• Provide data‑driven insights and strategic recommendations on UM performance.

Skills

Nurse leadership

Revenue cycle leadership

Budget management

Data analysis

Regulatory compliance

Education

Bachelor's Degree

Master's Degree in Nursing or related health field

Job description

Northeast Georgia Medical Center, Inc. is seeking a Director of Utilization Management to lead the UM functions, optimize reimbursement, and minimize denials. The role collaborates with hospital leadership, physicians, case management, finance, and compliance to enhance quality reporting and patient outcomes.

The position focuses on improving CMI, patient care transitions, and financial integrity, with a leadership approach that drives strategic initiatives and KPI tracking across the department.