Senior Director Utilization Managment and Health Plan

Health System seeking a Proven Utilization Management & Health Plan Leader

Company is growing and offers phenominal benefits

• This is a senior leader for the Health System and Medical Plan with responsibility for providing strategic and operational leadership for all utilization management functions across the organization.
• The role has unique regulatory and contractual compliance requirements for each line of business. Responsible for ensuring clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration.
• Senior Director partners closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals. In this capacity, the Director oversees multiple teams performing this work.
• This role reports to the Chief Medical Officer and collaborates closely with them to develop, update and implement the Utilization Management vision and strategy.

Must Have:

Hospital Experience

Must have compliance experience

Must be RN

Masters Degree is a must