Utilization Management Director

Insight Global; Washington (District of Columbia); On-site; USD 150,000 - 200,000; Full time

Job summary

Insight Global seeks a strategic Director of Utilization Management to lead UM operations across the DC and Maryland markets. The role requires healthcare leadership with deep expertise in managed care, utilization management, appeals, and concurrent review programs.

The Director will drive operational excellence, improve team performance, and enhance UM effectiveness while supporting members, providers, and organizational stakeholders.

Qualifications

• Proven people leadership experience in healthcare.
• Strong background in UM operations, program management and change leadership.
• Excellent communication and stakeholder management skills.

Responsibilities

• Oversee Appeals & Grievances processes for quality and compliance.
• Direct Concurrent Review operations and improvement initiatives.
• Develop and execute strategic initiatives to improve efficiency and outcomes.
• Partner with executive leadership to implement operational enhancements.
• Build, mentor, and develop high-performing UM teams.
• Drive change management and foster accountability and continuous improvement.

Skills

People leadership

Stakeholder management

Communication

Change leadership

Program management

Concurrent reviews

Job description

• Concurrent Reviews
• Proven people leadership experience.
• Strong operational improvement, program management, and change leadership background.
• Excellent communication and stakeholder management skills.

Preferred Qualifications

• Managed care/payor experience preferred.
• Medicaid experience strongly preferred.
• Experience leading operations across multiple markets.
• Combination of provider and payer experience highly desirable

Job description:

We are seeking a strategic and results-driven Director of Utilization Management to lead Utilization Management operations across the DC and Maryland markets. This role is ideal for an experienced healthcare leader with deep expertise in managed care, utilization management, appeals and grievances, and concurrent review programs.

The Director will be responsible for driving operational excellence, improving team performance, and enhancing the effectiveness of UM programs while supporting members, providers, and organizational stakeholders.

Key Responsibilities

• Oversee Appeals & Grievances processes to ensure quality, consistency, and compliance.
• Direct Concurrent Review operations and performance improvement initiatives.
• Develop and execute strategic initiatives that improve efficiency, outcomes, and member experience.
• Partner with executive leadership to identify and implement operational enhancements.
• Build, mentor, and develop high-performing UM teams.
• Drive change management efforts and foster a culture focused on accountability and continuous improvement.