Executive Director, Enterprise Utilization Management

Beth-Israel-Lahey-Health; Boston (MA); On-site; USD 180,000 - 210,000; Full time

Job summary

Beth Israel Lahey Health in Boston seeks an Executive Director of Utilization Management to lead enterprise-wide UM strategy, centralize operations, and align with payer requirements.

This senior role oversees standardizing policies, improving length of stay, and partnering with CMOs, physicians, and nursing leadership to ensure clinically appropriate and financially optimized care across all facilities.

Qualifications

• Bachelor’s degree in Nursing, Healthcare Administration, Health Information Management, or related healthcare field is required.
• Master’s degree strongly preferred.
• Active RN license preferred.
• Experience in Utilization Management, Case Management, or Revenue Cycle Operations is required.

Responsibilities

• Provide strategic and operational leadership for enterprise Utilization Management across all BILH facilities.
• Lead the transformation from decentralized to centralized UM with standardized processes.
• Develop and execute comprehensive utilization management strategies.
• Ensure CMS Conditions of Participation compliance and payer requirements.
• Oversee vendor partnerships and technology solutions (InterQual, MCG, etc.).
• Lead education and engagement of clinical leadership to reduce unnecessary admissions and length of stay.

Skills

Executive leadership

Strategic planning

Change management

Communication

Analytical skills

Vendor management

Epic EHR

Education

Bachelor’s degree in nursing/healthcare

Master’s degree preferred

Tools

Epic EHR

InterQual

MCG

Job description

Beth Israel Lahey Health in Boston seeks an Executive Director of Utilization Management to lead enterprise-wide UM strategy, centralize operations, and align with payer requirements.

This senior role oversees standardizing policies, improving length of stay, and partnering with CMOs, physicians, and nursing leadership to ensure clinically appropriate and financially optimized care across all facilities.