Vice President of Utilization Review

ICBD•Boca Raton, FL

5d•Onsite

About The Position

The Vice President of Utilization Review is responsible for overseeing the strategic direction and operational efficiency of revenue cycle management (RCM) functions, heavily focused on Out of Network (OON) with growing focus on In-Network (INN) and Medicaid. This is more than just an operational leadership role—it is an opportunity to drive business transformation, guide the organization to market, and be a key player in a high-growth, high-impact journey. The Vice President will be instrumental in shaping the future of RCM commercialization and will influence the broader trajectory of the company's expansion and success. The Vice President of Utilization Review will play a central role in implementing operational best practices, building scalable processes, and ensuring the seamless delivery of services while enhancing the company's competitive advantage in the industry. This role demands a strategic thinker with a deep understanding of RCM, a proven track record in operational leadership, and a passion for driving transformative change within a rapidly growing organization. The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position.

Requirements

Bachelor's degree in Business Administration, Healthcare Management, or a related field. An MBA or other advanced degree is highly preferred.
Minimum of 10 years of experience in operations management, with at least 5 years in a senior leadership role within the healthcare or RCM industry.
Minimum 5-7 years of experience in utilization review or a related healthcare management role.
Experience providing leadership and direction to a team to maintain and enhance customer relationships to meet the company objectives.
Proven track record of successfully scaling operations and leading large, cross-functional teams.
Strong strategic thinking and problem-solving skills, with the ability to translate vision into actionable plans.
Excellent leadership and team-building skills, with a focus on fostering a culture of accountability and high performance.
Exceptional communication and interpersonal skills, capable of engaging effectively with clients, partners, and internal teams.
Proficiency in data analysis and performance metrics, with a keen eye for identifying trends and opportunities for improvement.
Ability to manage multiple priorities in a fast-paced, dynamic environment.
Familiarity with RCM software and tools, as well as general IT systems used in healthcare operations.
Deep understanding of the healthcare industry, specifically out-of-network RCM, including regulatory requirements and payer landscapes.
Knowledge of market trends and best practices in RCM and healthcare operations.
High level of integrity and ethical standards.
Strong executive presence and the ability to inspire confidence and trust.
Adaptability and resilience in the face of challenges and change.

Nice To Haves

Experience with automation and AI integration in operational processes is a significant advantage.
Understanding of AI and automation technologies and their application in RCM processes.

Responsibilities

Collaborates with various departments, including medical staff, finance, case management, and quality assurance, to achieve optimal patient outcomes and financial performance.
Provide supervision and guidance to UR team, ensuring adherence to processes and protocols.
Serve as point of escalation point for complex UR cases and assist the team in developing strategies for challenging negotiations.
Conduct on-going audits of UR team members and report findings back to leadership.
Collaborate closely with the UR Director to implement process improvements and support the team's alignment with organizational goals.
Coordinate with clinical teams to support the department in gathering necessary documentation and developing individualized treatment plans for insurance submissions.
Monitor team performance, provide regular feedback, and facilitate professional development opportunities.
Build and scale high-performing teams that drive efficiency, accountability, and results.
Develop and refine client onboarding, integration, and management processes to support a growing external client base.
Shape the go-to-market strategy, working closely with business development and operational leaders to ensure seamless execution.
Leverage AI and automation to create a best-in-class RCM platform that differentiates us in the market.
Serve as the face of the company both internally and externally, representing our commitment to excellence and driving the vision forward. Lead with confidence, strategic foresight, and the ability to inspire teams to execute with precision.
Externally engage with clients, partners, and industry stakeholders to ensure our value proposition resonates and meets the expectations of a growing client base. Nurture relationships, secure buy-in, and demonstrate the unique advantages of our RCM offering while fostering a collaborative and partnership-driven environment.
Inspire a culture of accountability, high performance, and continuous improvement. Ensure operational health while creating an environment where teams feel empowered to excel, collaborate, and innovate.