Senior Director, Utilization Management & Payor Strategy

UF Health; Gainesville (FL); On-site; USD 150,000 - 210,000; Full time

Job summary

UF Health seeks a Director of Utilization Management to provide enterprise-wide leadership over medical necessity and level-of-care processes. This role manages admission, concurrent, and retrospective reviews, with escalation pathways and payor engagement to protect throughput and revenue integrity.

The ideal candidate will hold a BSN with an active RN license, 7–10 years in healthcare UM, and 3–5 years of leadership. Master’s degree preferred and CCM/ACM/CPHQ credentials are a plus.

Qualifications

• Bachelor’s degree in Nursing (BSN) required.
• Master’s degree preferred.
• Experience: 7–10 years in healthcare with utilization management.
• 3–5 years of leadership experience.
• Active RN license required.
• Preferred certifications: ACM, CCM, CMAC, CPHQ, and related UM/quality credentials.

Responsibilities

• Provide enterprise-wide leadership over medical necessity and LOC processes.
• Oversee admission, concurrent, and retrospective reviews, escalation pathways, and payor engagement.
• Drive clinical throughput, revenue integrity, and prevention of unnecessary denials.
• Partner with Physician Advisors, CM, Quality, CDI and Revenue Cycle leaders to improve payor outcomes.
• Lead teams, coach staff, and manage performance using KPIs and regulatory requirements.
• Translate CMS CoPs and Joint Commission standards into operational practice.

Skills

Leadership

Executive communication

Change leadership

Strategic thinking

Stakeholder management

Analytical skills

Team development

Education

BSN

Master’s degree preferred

RN license

Case management/ UM certifications preferred

Job description

UF Health seeks a Director of Utilization Management to provide enterprise-wide leadership over medical necessity and level-of-care processes. This role manages admission, concurrent, and retrospective reviews, with escalation pathways and payor engagement to protect throughput and revenue integrity.

The ideal candidate will hold a BSN with an active RN license, 7–10 years in healthcare UM, and 3–5 years of leadership. Master’s degree preferred and CCM/ACM/CPHQ credentials are a plus.