Director, Virtual Utilization Review

Ensemble Health Partners•Work at Home - Wisconsin - Other, WI

13d•$101,600 - $145,000•Remote

About The Position

The Director of Virtual Utilization Review will serve as a strategic leader focused on driving client partnerships, performance outcomes, and transformational change across people, process, and technology. This position emphasizes strategic oversight, data-driven decision-making, and relationship management rather than day-to-day workflow execution. You will lead complex, multi-client utilization review and utilization management operations while shaping the future of how we deliver value to our partners. This role will include travel, up to 25%.

Requirements

Bachelor’s degree or equivalent combination of education and experience
Current RN license
2+ years of leadership experience in multi-client utilization review / utilization management operations
Experience in Revenue Cycle Management (or equivalent healthcare leadership experience)
Experience managing geographically dispersed teams across the US and international locations
Demonstrated success in client relationship management and partnership development
Strategic mindset with experience driving organizational transformation and leading change management initiatives across people, process, and technology
Data-driven leadership approach, with strong analytical skills; proficiency in Power BI (for dashboard navigation and insights) preferred
Effective communication skills with the ability to organize and present information clearly and concisely
Strong technical skills including database and spreadsheet analysis and working knowledge of EMR(s) with front- and back-end understanding
Experience with project management tools preferred (AHA, Loop, Microsoft Project, or similar)

Responsibilities

Build strong, trusted relationships with clients and serve as a strategic partner
Develop a deep understanding of client KPIs and SLAs within the first 60 days
Identify and execute proactive opportunities to improve performance, satisfaction, and outcomes
Oversee complex multi-client utilization review and utilization management operations
Drive measurable improvements in performance, productivity, and SLA attainment
Lead data-driven decision-making using dashboards and analytics tools
Champion adoption of new technologies and investment capabilities
Lead large-scale change initiatives across people, process, and technology
Partner cross-functionally to implement process and system improvements
Lead, develop, and mentor a large, multi-layered team of 125–175 employees globally
Manage and empower direct reports including a minimum of 3 leaders
Foster a high-performing culture aligned with organizational values