Director, Utilization Management — Impact & Compliance

UNM HOSPITALS; Monte Largo Hills (NM); On-site; USD 100,000 - 140,000; Full time

Job summary

UNM Hospitals is seeking a leader to manage the Utilization Management program at UNM Health. The role includes day-to-day operations oversight, development and implementation of the program, and leadership of staff.

You will ensure compliance with state and federal regulations and coordinate with physicians and payers to optimize resource use. The position requires advanced credentials and experience with InterQual/MCG criteria, strong data analytics, and a commitment to patient safety and

Qualifications

• Experience with utilization management systems and regulatory requirements.
• Ability to lead staffing, training and performance evaluation.
• Strong data collection and outcome analysis skills.

Responsibilities

• Oversee day-to-day Utilization Management operations.
• Lead staffing, training and performance reviews.
• Develop and manage department budget and ensure adherence.
• Oversee utilization reviews from initial to concurrent stages.
• Coordinate with payers for optimal reimbursement.
• Perform quality reviews and data analysis for improvements.
• Lead process improvement initiatives and cross-team collaboration.
• Ensure patient safety policies are followed.
• Collect, prepare, and present data for committees.
• Provide staff development and training.

Skills

Interqual Criteria

MCG Criteria

Education

Master's Degree

BSN/Related Discipline

MSN or DNP

Job description

UNM Hospitals is seeking a leader to manage the Utilization Management program at UNM Health. The role includes day-to-day operations oversight, development and implementation of the program, and leadership of staff.

You will ensure compliance with state and federal regulations and coordinate with physicians and payers to optimize resource use. The position requires advanced credentials and experience with InterQual/MCG criteria, strong data analytics, and a commitment to patient safety and