We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida ...
We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida ...
Responsibilities The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient, Partial Hospital, Intensive Outpatient, ECT (River Point ...
Responsibilities The Director of Utilization Management is responsible for overseeing the Utilization Management Program for the Inpatient, Partial Hospital, Intensive Outpatient, ECT (River Point ...
Medical Director Utilization Management Oncology
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides clinical expertise in assessing the ...
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Medical Director Utilization Management Oncology
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides clinical expertise in assessing the ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...
Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
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Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is ... Refers cases to Plan Medical Director for medical necessity review when medical information ...
The ISNP Utilization Management Nurse is supervised by a Utilization Management Supervisor and is ... Refers cases to Plan Medical Director for medical necessity review when medical information ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
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Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
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Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...
Overview Make an impact by supporting the right care at the right time through utilization management excellence. RN Utilization Lead under the general supervision of the Director, is responsible for ...
Overview Make an impact by supporting the right care at the right time through utilization management excellence. RN Utilization Lead under the general supervision of the Director, is responsible for ...
Overview Make an impact by supporting the right care at the right time through utilization management excellence. RN Utilization Lead under the general supervision of the Director, is responsible for ...
Overview Make an impact by supporting the right care at the right time through utilization management excellence. RN Utilization Lead under the general supervision of the Director, is responsible for ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Under general supervision by management, and in collaboration with Medical Directors and other ... utilization information; assists with program processes for transitions across levels of care ...
Senior Director of Utilization Management Who We Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an ...
Senior Director of Utilization Management Who We Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an ...
Under general supervision by management, and in collaboration with Medical Directors and other ... The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization ...
Under general supervision by management, and in collaboration with Medical Directors and other ... The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization ...
Utilization Management Representative III Location: The selected candidate for this position must ... Ensuring UM Reps are directed to the appropriate resources to resolve issues. * Ability to ...
Utilization Management Representative III Location: The selected candidate for this position must ... Ensuring UM Reps are directed to the appropriate resources to resolve issues. * Ability to ...
Director Utilization Management information
See Florida salary details
$13.5K - $17.9K
1% of jobs
$17.9K - $22.4K
3% of jobs
$22.4K - $26.9K
11% of jobs
$29.8K is the 25th percentile. Wages below this are outliers.
$26.9K - $31.4K
16% of jobs
$31.4K - $35.9K
15% of jobs
The median wage is $37.2K / yr.
$35.9K - $40.4K
16% of jobs
$44.1K is the 75th percentile. Wages above this are outliers.
$40.4K - $44.8K
17% of jobs
$44.8K - $49.3K
9% of jobs
$49.3K - $53.8K
7% of jobs
$53.8K - $58.3K
3% of jobs
$58.3K - $62.8K
2% of jobs
$13.5K
$39.1K
$62.8K
How much do director utilization management jobs pay per year?
What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
What is a Director Utilization Management job?
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
What are the typical daily responsibilities of a Director Utilization Management?
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
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Full-time
Posted 4 days ago
Independent Living Systems rating
6.5
Based on 9 frontline employees who took The Breakroom Quiz
Job description
We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Director of Utilization Management plays an essential role in ensuring that healthcare services are delivered efficiently and effectively while maintaining high standards of member care. The Director of Utilization Management is responsible for overseeing the utilization management department, developing policies and procedures that align with regulatory requirements, and implementing best practices to optimize resource use. The Director of Utilization Management will collaborate with clinical teams to assess the appropriateness of care and ensure that members receive the right services at the right time. Additionally, the Director of Utilization Management involves analyzing data to identify trends and areas for improvement, ultimately enhancing member outcomes and satisfaction. The Director of Utilization Management will lead initiatives that promote cost-effective care while ensuring compliance with healthcare regulations and standards.
Minimum Qualifications:
- Bachelor's degree in Nursing, Healthcare Administration, or a related field.
- 5 years of experience in utilization management or a related healthcare field.
- Strong knowledge of healthcare regulations, policies, and best practices.
Preferred Qualifications:
- Master's degree in Healthcare Administration, Public Health, or a related field.
- Certification in Utilization Management (e.g., ACM, CCM) is highly desirable.
- Experience in a leadership role within a healthcare organization.
Responsibilities:
- Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
- Lead and direct a team of utilization management professionals, fostering a culture of continuous improvement and excellence.
- Direct the daily operations of the utilization management department, ensuring compliance with all regulatory requirements.
- Develop and implement utilization management policies and procedures that align with organizational goals.
- Collaborate with clinical staff to review and assess the appropriateness of care provided to members.
- Analyze utilization data to identify trends, areas for improvement, and opportunities for cost savings.
- Ensure that assigned deliverables are completed on time, including development and coordination of required contractual and regulatory submissions.
- Develop and track key performance indicators (KPIs) to measure organizational performance, including accurate and timely reporting of required contractual regulatory reports.
- Develop, maintain and improve management processes, policies and procedures and/or conduct management projects including development of detailed plans to achieve project objectives.
- Perform other duties as assigned.
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Benefits
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About Independent Living Systems
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
501 - 1,000 Employees
Headquarters location
Miami, FL, US
Year founded
2001