Director of Utilization Management & Case Management

  • Compensation: $115,000 - $130,000
  • Required Qualifications: RN with +3 years of experience as a Director of Utilization Management or Utilization Review, Care Management, Care Coordination, or Case Management
  • City/State: Altamonte Springs, FL

One of the fastest growing Utilization Management providers in the country is searching for a Director of Utilization Management to their team! The organization provides innovative Utilization Review and Case Management solutions for Health Plans who are looking to reduce cost and increase outcomes for high risk members who are considering invasive surgeries or implantable medical devices. You will be responsible for overseeing the Utilization Management function for multiple large health plan clients, including determining the team’s operational strategies, employee development, capacity planning, and operational policies and procedures.

They’ve grown from 70 full-time employees to nearly 150 and have plans to add another 50+ by the end of 2020! Despite their unbelievable success, the team stays close to their “small company” roots, and everyone feels like family. The senior leadership team includes some of the top physicians and executives in the country, but they are incredibly humble and approachable, making this a truly wonderful place to work!

The perks:

  • Ridiculously low healthcare costs
  • 401k
  • Tuition reimbursement
  • Gym discount
  • 4+ weeks PTO and Holidays
  • Small/family culture!

ResponsibilitiesWhile leading a team of 100 full-time employees and several Managers & Supervisors

  • Maintain and improves productivity and operations by monitoring system performance to identify and resolve problems
  • Mentoring and guiding the newer managers / supervisors
  • Leads process improvement initiatives to increase client team efficiency, performance and quality
  • Provide and support strategic direction for system development, including quality assurance testing of system enhancements and functionality
  • Develops and administers policies and procedures for utilization control of inpatient and outpatient services
  • Responsible for the maintenance of good community relationships with providers and clients to ensure a responsive system for authorization of services and payment of claims
  • Works with analytics team to monitor and report client performance metrics
  • Trains professional clinical and program staff on current principals and standards of practice of Utilization Management


  • Registered Nurse / RN / R.N.
  • Minimum 3 years of experience as a Director of Utilization Management or Utilization Review, Care Management, Care Coordination, or Case Management
  • Orthopedic, Spine, Pain Management, and/or Cardiology Experience, Preferred
  • We will consider candidates from a variety of settings such as a Health Plan, Hospital / Medical Center, MSO, or Medical Group

Final salary is per employer discretion and commensurate with experience.