Director, Virtual Utilization Review
About The Position
We are seeking a Director of Virtual Utilization Review to join our growing leadership team. This is a newly created, strategic leadership role within our Virtual Utilization Review (VUR) organization, focused on driving client partnerships, performance outcomes, and transformational change across people, process, and technology. Unlike traditional operational roles, 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.
Requirements
- Active Registered Nurse (RN) license
- Proven experience leading complex, multi-client utilization review / utilization management operations (RPM environment preferred)
- Strong background in Revenue Cycle Management (RCM) (or equivalent healthcare leadership experience)
- Experience managing multi-geography teams
- Demonstrated success in client relationship management and partnership development
- Strategic mindset with experience driving organizational transformation
- Data-driven leadership approach, with strong analytical skills
- Proficiency in Power BI (dashboard navigation and insights)
- Working knowledge of EMR systems (Cerner, Epic, or Meditech preferred) with both front- and back-end understanding
- Proficiency in Microsoft Office Suite
- Experience leading change management initiatives across people, process, and technology
Nice To Haves
- Experience with project management tools (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 (125–175 employees globally)
- Manage and empower direct reports (minimum of 3 leaders)
- Foster a high-performing culture aligned with organizational values
Benefits
- healthcare
- time off
- retirement
- well-being programs
- professional development
- tuition reimbursement
- quarterly and annual incentive programs
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
