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Director Utilization Management Jobs in Decatur, GA

Oscar Health

Manager, Strategy & Operations

Atlanta, GA · Remote

$105K - $138K/yr

... our Utilization Management Optimization and Strategy team. Oscar is the first health insurance ... You will report into the Senior Director, UM Optimization and Strategy. Work Location: This is a ...

Elevance Health

Medical Director - Surgery

Atlanta, GA · On-site

Medical Director - Surgery Location: This role enables associates to work virtually full-time, with ... Experience with utilization management, especially with CMS guidelines preferred. * Preferred board ...

Deloitte

Epic Tapestry Consultant

Atlanta, GA · On-site +1

Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work Experience/Direct Knowledge of ...

Deloitte

Epic Tapestry Sr Analyst

Atlanta, GA · On-site +1

Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Analytical/ Decision Making Responsibilities * Analytical ability to manage multiple projects and ...

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Director Utilization Management information

See Decatur, GA salary details

$17.6K

$51.1K

$82K

How much do director utilization management jobs pay per year?

As of Jun 5, 2026, the average yearly pay for director utilization management in Decatur, GA is $51,083.00, according to ZipRecruiter salary data. Most workers in this role earn between $39,100.00 and $58,600.00 per year, depending on experience, location, and employer.

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 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 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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Director Utilization Management jobs near you
Manager, Strategy & Operations

Manager, Strategy & Operations

Oscar Health

Atlanta, GA • Remote

$105K - $138K/yr

Other

PTO

Posted 21 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

227th of 260 rated insurance

Job description

Hi, we're Oscar. We're hiring a Manager, Strategy & Operations to join our Utilization Management Optimization and Strategy team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family.

About the role:

You will turn departmental goals into functional workflows, ensuring the team maintains high standards of accuracy and efficiency. You will manage the implementation of new clinical protocols, oversee organizational changes, and resolve technical or regulatory challenges to provide a seamless experience for members and providers.

You will report into the Senior Director, UM Optimization and Strategy.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $105,818 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

  • Lead end-to-end management of cross-functional projects and strategic initiatives, including the creation of project plans, development of executive-level presentations, and performance of ROI analysis to ensure alignment with business goals.
  • Evaluate departmental performance by gathering and interpreting data to develop metrics, track progress on priorities, and implement mitigation strategies for new needs.
  • Collaborate with internal and external stakeholders to formulate communication and program strategies, ensuring clarity and visibility for senior leadership while managing the most effective information channels.
  • Independently advance strategic initiatives by identifying potential roadblocks and navigating obstacles with a high degree of autonomy to meet tight deadlines.
  • Manage the design and facilitation of organization-wide events and programming, including Quarterly Townhalls and special projects.
  • Mentor team members and may directly oversee staff to promote professional growth and ensure consistent departmental execution.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • 4+ years of strategic planning or management consulting experience in the healthcare payer or provider space.
  • 3+ years of experience in delivering projects / programs
  • Executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
  • Experience using data and metrics to drive improvements in programs

Bonus points:

  • Experience with Prior Authorization lifecycles, medical benefits management, and the operational nuance of Utilization Management
  • Master's Degree
  • PMP Certifications or Program Management Certifications
  • Lean/Six Sigma Certifications

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