Strategic Director, Utilization Management & Programs

CareSource; United States; Remote; USD 136,000 - 237,000; Full time

Job summary

CareSource seeks a Director of Utilization Management Operations to support the UM Department in advancing initiatives, program development, and contract compliance. The role emphasizes leadership across clinical teams, regulatory alignment, and data-driven outcomes.

The position requires extensive experience in medical management operations, with preferred UM background and knowledge of Medicaid/Medicare/Managed Care, plus strong communication and project leadership skills.

Qualifications

• Bachelor's degree or equivalent years of relevant work experience is required.
• Master's degree in Health Care Administration and two years of post-degree professional experience is preferred.
• Minimum of five (5) years medical management operations, leadership, program, or management experience is required.
• Minimum of one (1) year Utilization Management experience preferred.
• Experience implementing programs with focus on integration is preferred.
• Experience with Medicaid, Medicare, Commercial and Managed Care is preferred.

Responsibilities

• Manages and prioritizes UM and related projects, ensuring timeliness and completion.
• Gathers and prioritizes business requirements for departmental requests including regulatory reporting.
• Monitors performance across programs to identify improvement opportunities and standardize evidence-based practices.
• Leads collaboration with clinical teams and stakeholders for coordination and communication.
• Supports readiness activities for implementation of new business and programs.
• Develops program documents and operational workflows.
• Engages stakeholders to ensure alignment across the organization.
• Recruits, develops, and leads key staff.

Skills

Visio

Word

Excel

PowerPoint

Project

Communication

Independent work

Organization

Time management

Analysis

Problem solving

Project management

Relationship building

Training & change agent

Critical thinking

Health services knowledge

Education

Bachelor's degree or equivalent

Master's degree in Health Care Administration

Job description

CareSource seeks a Director of Utilization Management Operations to support the UM Department in advancing initiatives, program development, and contract compliance. The role emphasizes leadership across clinical teams, regulatory alignment, and data-driven outcomes.

The position requires extensive experience in medical management operations, with preferred UM background and knowledge of Medicaid/Medicare/Managed Care, plus strong communication and project leadership skills.