Director of Utilization Management
About The Position
The Director of Utilization Management provides strategic leadership, oversight and operational management for all utilization review and medical necessity processes within the health system. This role ensures patient care is delivered at the appropriate level of care, ensures regulatory compliance, optimizes patient flow, supports high-quality clinical outcomes, and manages resource utilization across the acute care continuum. The Director collaborates with medical staff, nursing, revenue cycle and external partners to optimize patient throughput, reduce denials, and improve overall efficiency in care delivery.
Requirements
- Bachelor's degree in Nursing or related healthcare field.
- Current RN license in the state of practice.
- Minimum 7-10 years of experience in acute care hospital setting.
- At least 3-5 years in a utilization management or case management leadership role.
- Strong understanding of managed care principles, hospital reimbursement, and regulatory compliance.
Nice To Haves
- Master's degree in Nursing, Health Administration, or related field.
- Certification in Case Management (CCM or ACM).
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What This Job Offers
Job Type
Full-time
Career Level
Director
Industry
Executive, Legislative, and Other General Government Support
Number of Employees
1,001-5,000 employees
