Senior Director of Utilization Management RN
The Jacobson Group, Denver, CO, United States
We are seeking an experienced Utilization Management leader to oversee operations and provide strategic direction for the UM department. This hybrid opportunity is based in
Denver, CO
and involves managing a team while ensuring compliance with regulatory and contractual requirements across multiple lines of business.
Responsibilities
Provide leadership, management, and oversight of the Utilization Management (UM) department, supervising approximately 15 team members.
Ensure adherence to turnaround times and contractual compliance requirements for prior authorizations, medical necessity reviews, and concurrent/retrospective reviews.
Oversee coordination of peer-to-peer (P2P) reviews and related utilization management processes.
Guide continuous improvement initiatives related to information systems, productivity, and policy alignment with CMS and market standards.
Support ongoing operational initiatives, including optimization of auto-authorization workflows and vendor-supported P2P and automation processes.
Requirements
Minimum
7 years of utilization management experience
within a health plan or healthcare provider setting.
Strong familiarity with
MCG criteria and Guiding Care
required.
Minimum
4 years of supervisory or management experience .
Proven collaborative leadership and team management skills.
Experience with
QNXT preferred .
Cross-functional experience with
claims, grievances/appeals, and care management preferred .
Key Skills
Medical Necessity Review & Prior Authorization
Process Improvement & Workflow Optimization
Regulatory & CMS Compliance
Cross-Functional Healthcare Operations
Pay Range $70 – $80 per hour
Benefits
Medical insurance
Vision insurance
401(k) retirement savings plan
Contact kruch@jacobsongroup.com
Refer a Colleague If you know someone who may be interested in this opportunity, please have them reach out to the contact above or submit their information through our referral program. Qualified referrals may be eligible for a referral bonus through our referral program.
Equal Opportunity Employer The Jacobson Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you need assistance or an accommodation during the application process, please contact our HR team at
HR@jacobsononline.com
or call
+1 (800) 466-1578 .
#J-18808-Ljbffr
Denver, CO
and involves managing a team while ensuring compliance with regulatory and contractual requirements across multiple lines of business.
Responsibilities
Provide leadership, management, and oversight of the Utilization Management (UM) department, supervising approximately 15 team members.
Ensure adherence to turnaround times and contractual compliance requirements for prior authorizations, medical necessity reviews, and concurrent/retrospective reviews.
Oversee coordination of peer-to-peer (P2P) reviews and related utilization management processes.
Guide continuous improvement initiatives related to information systems, productivity, and policy alignment with CMS and market standards.
Support ongoing operational initiatives, including optimization of auto-authorization workflows and vendor-supported P2P and automation processes.
Requirements
Minimum
7 years of utilization management experience
within a health plan or healthcare provider setting.
Strong familiarity with
MCG criteria and Guiding Care
required.
Minimum
4 years of supervisory or management experience .
Proven collaborative leadership and team management skills.
Experience with
QNXT preferred .
Cross-functional experience with
claims, grievances/appeals, and care management preferred .
Key Skills
Medical Necessity Review & Prior Authorization
Process Improvement & Workflow Optimization
Regulatory & CMS Compliance
Cross-Functional Healthcare Operations
Pay Range $70 – $80 per hour
Benefits
Medical insurance
Vision insurance
401(k) retirement savings plan
Contact kruch@jacobsongroup.com
Refer a Colleague If you know someone who may be interested in this opportunity, please have them reach out to the contact above or submit their information through our referral program. Qualified referrals may be eligible for a referral bonus through our referral program.
Equal Opportunity Employer The Jacobson Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you need assistance or an accommodation during the application process, please contact our HR team at
HR@jacobsononline.com
or call
+1 (800) 466-1578 .
#J-18808-Ljbffr