Senior Director, Health Plan Utilization Management
Denver Health
full-time
Posted on:
Location Type: Hybrid
Location: Denver • Colorado • United States
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Salary
💰 $139,200 - $222,700 per year
Job Level
About the role
- Provide strategic and operational leadership for all utilization management functions across the organization.
- Ensure clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration.
- Partner closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals.
- Oversee multiple teams performing utilization management functions.
- Develop, implement, and evaluate formal educational activities and follow up on issues identified through educational activities.
- Ensure DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit.
Requirements
- Master's degree required
- Graduation from an accredited educational program for Nursing or Physician’s Assistants required
- Seven years of experience in administration in managed care, health plan administration or healthcare provider organizations required
- Minimum of five years of supervisory and management experience required
- 1-3 years Health Plan or healthcare experience with various lines of business including Medicare, Medicaid, CHP, Exchange and/or Commercial Plans required
- 1-3 years Experience in managing vendors required
- Knowledge of regulatory and accreditation standards for health plan or healthcare operations required
- Strong program development, analysis, and evaluation skills required
- Strong knowledge and experience in utilization principles, concepts, and strategies preferred
Benefits
- Outstanding benefits including up to 27 paid days off per year
- Immediate retirement plan employer contribution up to 9.5%
- Generous medical plans
- Free RTD EcoPass (public transportation)
- On-site employee fitness center and wellness classes
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education & development opportunities including career pathways and coaching
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementprogram developmentanalysisevaluationregulatory compliancehealth plan administrationmanaged carevendor managementhealthcare operationsutilization principles
Soft Skills
strategic leadershipoperational leadershipcollaborationteam managementeducational developmentproblem-solvingcommunicationorganizational skillsquality assurancecost-effectiveness
Certifications
Master's degreeNursing program accreditationPhysician’s Assistant program accreditation