Strategic Director, Utilization Management (Remote)

Integra Partners; United States; Teletrabalho; USD 144 000 - 176 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive compensation and annual/bi

401(k) retirement program with company

Company-paid life insurance

Short term disability coverage

Medical, Vision, Dental benefits

PTO

Paid Parental Leave

Sick Time

Holidays and floating holidays

Quarterly events

Health and wellness programs

Career development opportunities

Resumo da oferta

Integra Partners seeks an experienced Director of Utilization Management to lead clinical and non-clinical UM teams for a managed care organization. You will drive UM program delivery to health plan clients, grow the UM business, and collaborate with leadership to operationalize robust UM processes.

You will manage audits, QA, and NCQA certification efforts, develop staffing models, and work with account managers to meet contractual performance.

Qualificações

• Bachelor’s degree in area of specialty is preferred.
• Analytical ability and clinical knowledge to assess medical records and trends.
• Strong written and verbal communication for cross-functional collaboration.

Responsabilidades

• Direct clinical and non-clinical UM teams for a managed care organization.
• Develop and operationalize UM programs in collaboration with executives.
• Ensure timely reviews, authorizations, and appeals with QA and NCQA alignment.
• Lead quality improvement activities and audits of medical criteria.
• Oversee staffing models and policies for scalable operations.

Conhecimentos

Analytical ability

Communication skills

Interpersonal skills

Formação académica

Bachelor’s degree in area of specialty, preferred

Descrição da oferta de emprego

Integra Partners seeks an experienced Director of Utilization Management to lead clinical and non-clinical UM teams for a managed care organization. You will drive UM program delivery to health plan clients, grow the UM business, and collaborate with leadership to operationalize robust UM processes.

You will manage audits, QA, and NCQA certification efforts, develop staffing models, and work with account managers to meet contractual performance.