Director Utilization Mgmt

Wellpath / Correct Care Solutions; Cleveland (OH); On-site; USD 199,992 - 249,995; Full time

Benefits offered by this job

Comprehensive benefits including medical, dental, and vision

DailyPay – receive your money as you earn it

Tuition Assistance and dependent scholarships

Employee Assistance Program (EAP)

Company-paid life insurance

Tax-free Health Spending Account (HSA)

Wellness program

Preferred banking partnership discounts

Job summary

A healthcare services provider is seeking a Director of Utilization Management to lead the development and execution of utilization review initiatives. This role entails overseeing case management, guiding medical staff to ensure quality patient care, and collaborating with external stakeholders. Candidates must be a licensed Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) and have a year of experience in utilization management. Competitive salary and benefits are available.

Qualifications

• One year of experience in utilization management required.
• Experience in performance and/or quality improvement preferred.

Responsibilities

• Lead and oversee utilization review and case management.
• Ensure the use of nationally recognized criteria for reviews.
• Manage UM staff for performance and development.

Skills

Excellent communication skills

Organizational skills

Performance improvement

Education

Medical Doctor (M.D.) or Osteopathic Doctor (D.O.)

Job description

We're on a path to better healthcare. Join us.

Position: Director Utilization Management (Relocation Bonus Available)

Compensation: $199,992 - $249,995.2 / year

Department: Regional Office Location: Lemoyne, Pennsylvania (Onsite)

You Matter

• Make a difference every day in the lives of the underserved.
• Join a mission‑driven organization with a people‑first culture.
• Excellent career growth opportunities.
• Caring for overlooked, underserved, and vulnerable patients.
• Diversity, equity, inclusion, and belonging.
• Autonomy in a warm team environment.
• Growth and training.

Perks and Benefits

• Comprehensive benefits including medical, dental, vision, paid time off, and 401(k).
• DailyPay – receive your money as you earn it.
• Tuition Assistance and dependent scholarships.
• Employee Assistance Program (EAP) with free counseling and health coaching.
• Company‑paid life insurance.
• Tax‑free Health Spending Account (HSA).
• Wellness program: fitness memberships and product discounts.
• Preferred banking partnership with discounted rates for home and auto loans.
• *Eligibility for perks and benefits varies by employee type and length of service.

How you make a difference

The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within the assigned area. They provide guidance and direction to medical staff to ensure quality patient care and appropriate utilization of medical services. They serve as a key liaison with external partners and stakeholders and collaborate with internal teams to optimize care delivery and achieve operational goals.

Key Responsibilities

• Ensure the use of nationally recognized criteria and evidence‑based standards for inpatient concurrent reviews and off‑site service requests.
• Manage UM staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Lead UM process improvements, facilitate patient care goals, and use data research to reduce length of inpatient stays and decrease ED admissions.
• Evaluate and recommend policy improvements related to the utilization review system; provide UM updates and participate in meetings.
• Establish and monitor progress toward UM program goals, maintain off‑site service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical staff regarding off‑site services.

Qualifications & Requirements

Education

• Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university.

Experience

• One (1) year of experience in utilization management is required.
• Excellent communication and organizational skills required.
• Experience in performance and/or quality improvement preferred.

Licenses/Certifications

• Current medical license in the state of employment.

We are an Equal Employment Opportunity/Affirmative Action Employer

We celebrate diversity and are committed to creating an inclusive environment for all employees.

If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.