DevotedHiring

Director, Utilization Management Operations

  • Remote, United States
  • Lead
  • Posted 3 days ago
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In one line

Lead the admin side of utilization management for a health insurer: about 50 in-house coordinators plus an offshore vendor, fully remote with Eastern hours.

About the role

A curious operations leader who enjoys taking a messy process apart and rebuilding it simpler fits here. The work decides how fast and fairly members get answers on care requests.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Lead
Working hours
Eastern Time hours
Skills
Utilization Management, AI tools, Vendor management
Posted
1 Nov 2026
Last checked
3 Nov 2026

What you will do

  • Own service level performance for the admin steps behind authorization review, at lower cost
  • Share accountability for Part B medical authorization turnaround times with clinical leads
  • Map intake, extra clinical information requests, census checks, notifications and follow-up, then redesign them
  • Work with Product and Engineering on the internal platform roadmap and put AI tools to use
  • Lead roughly 50 onshore coordinators and their managers, and manage an offshore vendor of over 250 people
  • Set KPIs with Data Science: timeliness, cost per authorization, quality, provider experience

What they look for

  • Experience leading utilization management or similar administrative operations at scale
  • Comfort running large onshore and offshore teams and vendor relationships
  • A track record of redesigning processes for speed and consistency
  • Ability to work Eastern Time hours from anywhere in the US, with travel twice a year

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Questions about this job

Is this job fully remote, and from where?

The posting lists it as remote for people in the United States. On hours, the posting says: Eastern Time hours.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a lead role. The posting asks for: experience leading utilization management or similar administrative operations at scale; comfort running large onshore and offshore teams and vendor relationships; a track record of redesigning processes for speed and consistency. Skills it names include Utilization Management, AI tools, Vendor management.

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