Director, Utilization Management & Clinical Operations

CommunityCare, Inc.; Tulsa (OK); On-site; USD 180,000 - 250,000; Full time

Job summary

CommunityCare, Inc. in Tulsa, OK seeks a Director of Utilization Management to lead the Physical Health UM department under the Chief Medical Officer. You will guide a large team, drive compliance, and develop data-driven strategies to improve clinical appropriateness, affordability, efficiency, and quality.

The role requires expert UM knowledge, strong analytics, and proven leadership. You will oversee prospective, concurrent, and retrospective reviews, ensure regulatory alignment, and

Qualifications

• Expert knowledge of health plan utilization management operations and regulatory standards.
• Ability to translate utilization data into strategy and measurable results.
• Proven experience leading large, multi-layered clinical operations teams.
• Proficiency with analytics tools, automation, and emerging technologies.

Responsibilities

• Direct strategy and daily operations of Physical Health Utilization Management.
• Set expectations for workload, staffing, productivity, quality, and timelines.
• Lead Utilization Management supervisors and workforce planning.
• Analyze data to identify trends and implement improvements.
• Evaluate prior authorization and other utilization controls.
• Ensure benefits are applied consistently and in compliance with requirements.
• Collaborate across clinical and operational teams to improve outcomes.
• Oversee technology adoption, including AI-assisted tools and CDS.
• Manage delegated UM performance and optimal operating model.
• Provide reporting and recommendations on performance and risks.
• Perform other duties as required.

Skills

UM operations expert

Data analysis & interpretation

Leadership & people management

Cross-functional collaboration

Compliance & regulatory knowledge

Change management

Education

BSN

Master's degree preferred

Tools

Utilization management platforms

Analytics & visualization tools

Microsoft applications

AI-assisted workflows

Job description

CommunityCare, Inc. in Tulsa, OK seeks a Director of Utilization Management to lead the Physical Health UM department under the Chief Medical Officer. You will guide a large team, drive compliance, and develop data-driven strategies to improve clinical appropriateness, affordability, efficiency, and quality.

The role requires expert UM knowledge, strong analytics, and proven leadership. You will oversee prospective, concurrent, and retrospective reviews, ensure regulatory alignment, and