Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement)
Core
Senior leader responsible for strategic and operational leadership of all utilization management functions, ensuring clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations.
Role type
Senior Director, Health Plan Utilization Management
Builds
Utilization management strategies, policies, and processes for the Denver Health Medical Plan
Domain
Healthcare administration / Managed care
Required skills
Strategic leadership, regulatory compliance, program development, data analysis, vendor management, stakeholder engagement
Preferred skills
Utilization management principles, multidisciplinary team collaboration
Technologies
Utilization management software systems
Responsibilities
Oversee maintenance and improvement of UM policies and procedures; Ensure compliance with contractual and regulatory requirements; Develop and present reports on productivity, quality, and outcomes; Serve as liaison between UM and other departments/agencies; Lead staff training on relevant software applications; Participate in Quality Management and Utilization Management committees
Seniority
Senior Director, strategic leadership & team oversight
