Senior Director of Utilization Management, RN
Confidential, Denver, CO, United States
Senior Director of Utilization Management, RN
About the Company
Reputable health insurance provider
Industry Insurance
Type Privately Held
About the Role
The Company is in search of a Senior Director of Utilization Management with an RN background to lead and provide strategic direction for the department. The successful candidate will be responsible for overseeing the operations of the utilization management department, ensuring compliance with regulatory and contractual requirements across multiple lines of business. This role involves managing a team, supervising the adherence to turnaround times, and coordinating various utilization management processes, including peer-to-peer reviews. The Senior Director will also be instrumental in guiding continuous improvement initiatives and supporting operational activities such as the optimization of workflows and vendor-supported processes.
Applicants must have an active RN license in Colorado, a minimum of 7 years' of utilization management experience within a health plan or healthcare provider setting, and a strong familiarity with MCG criteria and Guiding Care. The role requires at least 4 years' of supervisory or management experience, proven collaborative leadership, and team management skills. Experience with QNXT and cross-functional experience with claims, grievances/appeals, and care management are preferred. The ideal candidate will be adept at leading a team, ensuring compliance, and driving operational excellence in the utilization management function.
Travel Percent Less than 10%
Functions
Medical Care/Hospital Administration Operations
About the Company
Reputable health insurance provider
Industry Insurance
Type Privately Held
About the Role
The Company is in search of a Senior Director of Utilization Management with an RN background to lead and provide strategic direction for the department. The successful candidate will be responsible for overseeing the operations of the utilization management department, ensuring compliance with regulatory and contractual requirements across multiple lines of business. This role involves managing a team, supervising the adherence to turnaround times, and coordinating various utilization management processes, including peer-to-peer reviews. The Senior Director will also be instrumental in guiding continuous improvement initiatives and supporting operational activities such as the optimization of workflows and vendor-supported processes.
Applicants must have an active RN license in Colorado, a minimum of 7 years' of utilization management experience within a health plan or healthcare provider setting, and a strong familiarity with MCG criteria and Guiding Care. The role requires at least 4 years' of supervisory or management experience, proven collaborative leadership, and team management skills. Experience with QNXT and cross-functional experience with claims, grievances/appeals, and care management are preferred. The ideal candidate will be adept at leading a team, ensuring compliance, and driving operational excellence in the utilization management function.
Travel Percent Less than 10%
Functions
Medical Care/Hospital Administration Operations