Senior Director, Utilization Management & Compliance

Texas Health Institute; Pearland (TX); Hybrid; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Director of Utilization Management to provide executive leadership and strategic direction for all UM functions across inpatient and outpatient care. This role ensures regulatory compliance with CMS, state regulators, and accrediting bodies, while guiding policy development and reporting across the department.

The ideal candidate holds a Bachelor's degree with an active Texas RN license, and has 10+ years in managed care, including 5+ years in a management role.

Qualifications

• Bachelor's Degree is required
• Active Texas RN license or valid compact RN license
• 10+ years in managed care health insurance field, with 5 years in management
• Experience analyzing complex regulations, government contract requirements, and policies and procedures

Responsibilities

• Provide executive leadership, strategic direction, and operational oversight for Utilization Management
• Ensure compliance with CMS, Texas DIO, NCQA, URAC, and delegated plans
• Develop and maintain policies, regulatory submissions, and reporting processes
• Oversee utilization review activities across inpatient, outpatient, and retrospective reviews

Skills

10+ years managed care experience

5+ years in management

Regulatory analysis

Education

Bachelor's Degree

RN license (Texas)

Job description

UnitedHealth Group is seeking a Director of Utilization Management to provide executive leadership and strategic direction for all UM functions across inpatient and outpatient care. This role ensures regulatory compliance with CMS, state regulators, and accrediting bodies, while guiding policy development and reporting across the department.

The ideal candidate holds a Bachelor's degree with an active Texas RN license, and has 10+ years in managed care, including 5+ years in a management role.