Remote Director, Utilization Management & Operations

Integra Partners; Michigan; Hybrid; USD 140,000 - 180,000; Full time

Benefits offered by this job

Competitive compensation and annual/bi

401(k) retirement program with company

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Job summary

Integra Partners is seeking an experienced Utilization Management leader to direct clinical and non-clinical UM teams within a managed care organization. You will drive program delivery, growth, and operationalization of the UM initiative across health plan clients.

You will oversee policies, certifications, quality improvement, and collaboration with executives to ensure alignment with contracts and corporate goals. Michigan-based role with remote workforce options.

Qualifications

• Bachelor’s degree in area of specialty, preferred.
• Minimum of 10 years of UM management experience in a managed care setting.
• Experience with UM NCQA or URAC certification/accreditation.
• Experience with leading and managing teams of clinical and non-clinical staff.
• Analytical ability and clinical knowledge to assess medical records, identify trends, and report findings.
• Strong verbal and written communication skills.
• Solid interpersonal skills to build cooperative relationships.

Responsibilities

• Prepare and maintain Utilization Review Plan policies and procedures.
• Obtain or maintain certification or license in states when performing Utilization Review.
• Define UM criteria with Chief Medical Director and ensure alignment with corporate initiatives.
• Manage UM Department staff to ensure timely reviews of prior authorizations and appeals.
• Lead quality improvement activities including audits and IRR testing.
• Ensure UM program meets contractual requirements with client-facing teams.
• Represent the UM team in business development and client reviews as needed.
• Oversee third-party technology configuration of medical management software.

Skills

Leadership

Analytical ability

Communication skills

Interpersonal skills

Education

Bachelor's degree

Job description

Integra Partners is seeking an experienced Utilization Management leader to direct clinical and non-clinical UM teams within a managed care organization. You will drive program delivery, growth, and operationalization of the UM initiative across health plan clients.

You will oversee policies, certifications, quality improvement, and collaboration with executives to ensure alignment with contracts and corporate goals. Michigan-based role with remote workforce options.