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Director Quality Utilization Management Jobs (NOW HIRING)

P3 Health Partners

Manager Utilization Management

Omaha, NE · On-site

$100K - $140K/yr

Lead the Team That Drives Quality, Compliance, and Exceptional Patient Care Are you an experienced ... Partner with Medical Directors to support medical necessity determinations and coordination of care ...

INTUS INC

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost ... This individual partners closely with PACE Interdisciplinary Teams, Medical Directors, and provider ...

Integra Partners

Director of Utilization Management

Troy, MI · On-site +1

$160K - $160K/yr

Integra's Utilization Management (UM) division is looking for an experienced individual to direct ... Responsible for UM-related quality improvement activities, including conducting audits to ensure ...

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Director Quality Utilization Management information

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How much do director quality utilization management jobs pay per year?

As of Sep 11, 2026, the average yearly pay for director quality utilization management in the United States is $105,577.00, according to ZipRecruiter salary data. Most workers in this role earn between $80,500.00 and $130,000.00 per year, depending on experience, location, and employer.

What does a director quality utilization management do?

A Director of Quality Utilization Management oversees processes that ensure healthcare services are delivered efficiently, appropriately, and with high quality. They develop and implement strategies for utilization review, quality assurance, and compliance with regulatory standards. This role involves collaborating with clinical staff, analyzing data to improve patient outcomes, and managing teams to meet organizational goals. Directors also play a key role in policy development and training related to utilization management.

How does a director quality utilization management typically collaborate with clinical and administrative teams to achieve organizational goals?

The Director of Quality Utilization Management works closely with both clinical and administrative teams to ensure effective resource utilization and compliance with care quality standards. This often involves leading interdisciplinary meetings, developing and implementing utilization review protocols, and providing guidance on best practices for patient care and cost management. The role requires strong communication and leadership skills to bridge gaps between departments, facilitate data-driven decision-making, and drive continuous improvement initiatives. Collaboration with physicians, case managers, and IT specialists is common, ensuring that organizational goals around quality and efficiency are consistently met.

What are the key skills and qualifications needed to thrive as a director quality utilization management, and why are they important?

To thrive as a Director of Quality Utilization Management, you need a comprehensive understanding of healthcare quality improvement, utilization review, and regulatory compliance, typically supported by a clinical degree (such as RN, MD, or related field) and management experience. Expertise with healthcare analytics platforms, case management software, and familiarity with accreditation standards (such as NCQA or URAC) are commonly required, along with certifications like CPHQ or CCM. Strong leadership, analytical thinking, and effective communication skills set top performers apart in managing teams and collaborating across departments. These skills and qualifications are vital for optimizing patient outcomes, ensuring regulatory adherence, and driving organizational efficiency.

What are popular job titles related to Director Quality Utilization Management jobs?

For Director Quality Utilization Management jobs, the most frequently searched job titles are:

Infographic showing various Director Quality Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $105,577 per year, or $50.8 per hour.

Manager Utilization Management

Omaha, NE • On-site

P3 Health Partners
Health Care and Social Assistance • 51 - 200 employees
Learn more about P3 Health Partnersexternal

$100K - $140K/yr

Full-time

Re-posted 11 hours ago

Key responsibilities

  • Oversee and manage the daily operations of the Utilization Management department, including staff supervision and performance management.

  • Monitor workflows to ensure efficiency, accuracy, and compliance with regulations and organizational standards.

  • Collaborate with cross-functional teams and support organizational initiatives related to quality, compliance, and process improvement.

P3 Health Partners rating

6.6

Company rating: 6.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Lead the Team That Drives Quality, Compliance, and Exceptional Patient Care
Are you an experienced nursing leader with a passion for utilization management, operational excellence, and team development? P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of our Utilization Management (UM) department and help drive quality, efficiency, and compliance across the organization.
In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and operational stakeholders, and play a vital role in ensuring members receive the right care at the right time. You'll have the opportunity to influence processes, mentor staff, support organizational growth, and contribute to initiatives that improve both patient outcomes and healthcare value.
What You'll Do
As the Utilization Management Manager, you'll provide leadership, oversight, and expertise to ensure the UM department operates effectively while meeting regulatory and organizational standards.
Key Responsibilities
  • Lead and manage the daily operations of the Utilization Management department, including staff supervision, coaching, and performance management.
  • Monitor departmental workflows to ensure efficiency, accuracy, and compliance with applicable regulations and organizational requirements.
  • Serve as a subject matter expert and resource for UM staff, providing ongoing education, mentorship, and support.
  • Promote a culture of quality, accountability, and continuous improvement across the department.
  • Participate in Utilization Management and Quality Assurance committees and support organizational quality initiatives.
  • Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS, and other regulatory entities.
  • Collaborate with cross-functional teams including Case Management, Clinical Operations, Quality Improvement, Claims, Network Development, Configuration, and Finance.
  • Develop, implement, and maintain departmental policies, procedures, and workflow standards.
  • Identify process improvement opportunities and provide recommendations for system enhancements and operational efficiencies.
  • Maintain expertise in Medicare Advantage regulations, managed care requirements, and provider/facility contract provisions.
  • Partner with Medical Directors to support medical necessity determinations and coordination of care activities.
  • Participate in strategic planning, budgeting activities, and organizational growth initiatives.
  • Support implementation efforts related to new markets, programs, and business expansion.

What Makes You Successful
You are a collaborative healthcare leader who balances strong clinical knowledge with operational expertise and a commitment to excellence.
Core Competencies
  • Comprehensive knowledge of Medicare Advantage regulations, utilization management practices, and healthcare compliance requirements.
  • Strong leadership and team development skills.
  • Excellent verbal and written communication abilities, including presenting complex information to diverse audiences.
  • Strong organizational and project management capabilities.
  • Ability to prioritize competing demands in a fast-paced environment.
  • Sound judgment, critical thinking, and decision-making skills.
  • Ability to foster strong relationships across departments and levels of the organization.
  • Experience utilizing referral management systems, MCG criteria, CMS guidelines, and payer portals.
  • Continuous improvement mindset focused on quality, efficiency, and member outcomes.

Qualifications
Required
  • Graduate of an accredited school of nursing.
  • Active, unrestricted Registered Nurse (RN) license in the state of Arizona, California, Nebraska, Nevada, or Oregon.
  • Ability to obtain licensure in all delegated markets within one year of hire.
  • Minimum of five (5) years of clinical nursing experience.
  • Minimum of two (2) years of experience within managed care, an HMO, or a global risk-bearing provider organization.
  • Minimum of two (2) years of supervisory or management experience.
  • Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Preferred
  • Bachelor's degree in Nursing (BSN).
  • Experience leading utilization management teams within a Medicare Advantage environment.
  • Experience supporting regulatory audits and accreditation activities.

Work Hours & Travel
  • Monday - Friday; occasional oversight of Saturday/Sunday progress; 8 AM - 5 PM CT
  • This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
  • Occassional travel to delegated markets (currently AZ, CA, NE, NV, OR).

Salary Range: $100,000 - $140,000 annually.
The posted salary range reflects P3 Health Partners' good-faith estimate for this role at the time of posting. Placement within the range will be based on qualifications, experience, education, geographic location, and internal equity considerations. In addition to base salary, eligible employees may have access to a comprehensive benefits package and other compensation opportunities.
Why Join P3?
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients. We are a physician-led organization relentless in our mission to overcome obstacles and positively disrupt the business of healthcare, transforming it from sickness care into wellness guidance.
As a Utilization Management Manager, you'll play a critical role in helping ensure our members receive high-quality, coordinated, and cost-effective care. You'll work alongside dedicated healthcare professionals and leaders who are committed to innovation, collaboration, and improving the healthcare experience for both patients and providers.
At P3, you'll have the opportunity to make a meaningful impact while growing your career in a fast-paced and evolving organization. If you are passionate about your work, eager to have fun, and motivated to be part of a mission-driven team, we encourage you to join us.
Help shape the future of healthcare while leading a team committed to clinical excellence and positive patient outcomes.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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