Director of Utilization Management & Case Management

Position Summary

The Director of Utilization Management & Case Management provides strategic and operational leadership for UM and CM programs. This role is responsible for driving clinical programming, regulatory compliance, process improvement, and team performance while partnering with senior leadership, clients, and client services to support continued growth.

Key Responsibilities

• Lead and manage UM and CM staff, fostering high performance and professional development
• Ensure compliance with clinical standards and applicable state regulations
• Drive process improvement, efficiency and development
• Serve as clinical UM SME for business development, RFPs and new product launches
• Collaborate cross-functionally with Member Services, Client Services, PBM Clinical, and IT teams
• Support client relationships, reporting reviews, and strategic planning
• Participate in sales presentations and client meetings as needed

Qualifications

• Bachelor’s degree in nursing
• Clinical background with managed care experience
• Progressive experience in healthcare operations
• Experience working with senior leadership and ability to meet with clients
• Experience in utilization management and case management
• Experience with self-funded groups and InterQual? criteria preferred
• Strong communication, analytical, and leadership skills / potential
• Ability to travel as needed (approximately 10%)

Must be able to commute to Grosse Pointe Park, MI.

Pay: $125,000.00 - $140,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Grosse Pointe Park, MI 48230