Senior Director, Health Plan Utilization Management

Nearterm; Denver (CO); On-site; USD 100,000 - 150,000; Full time

Job summary

Nearterm is seeking a Director of Health Plan Utilization Management to lead strategic and operational functions within a large health system. This senior role focuses on ensuring compliance and high-quality member outcomes.

The ideal candidate will have a Master's Degree and RN, overseeing teams to align utilization management strategy with organizational goals while addressing regulatory and contractual requirements.

Qualifications

• Must have a Master's Degree.
• Must have a Registered Nurse (RN) license.

Responsibilities

• Train staff on relevant software involved in job functions.
• Present reports to the Operations Team and Board of Directors.
• Participate in Quality Management and other related meetings.
• Serve as liaison between Utilization Management and other departments.
• Oversee development and improvement of UM policies and procedures.
• Analyze and present reports on productivity and outcomes.
• Ensure documentation of compliance with regulatory requirements.

Education

Master's Degree

Registered Nurse (RN)

Job description

Nearterm is seeking a Director of Health Plan Utilization Management to lead strategic and operational functions within a large health system. This senior role focuses on ensuring compliance and high-quality member outcomes.

The ideal candidate will have a Master's Degree and RN, overseeing teams to align utilization management strategy with organizational goals while addressing regulatory and contractual requirements.