Director, Utilization Review

LightHouse (LTHS) Studio

Director of Utilization Review managing teams in operational execution at Long Tail Health Solutions. Building client relationships and ensuring compliance with healthcare regulations in a hybrid work environment.

Posted 5/16/2026full-time🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Manage frontline managers, supervisors, utilization nurses, coordinators, and support staff
Provide coaching, mentorship, and performance management to operational staff
Ensure adherence to payer guidelines, regulatory standards, and internal operational policies
Ensure operational efficiency, productivity, timeliness, and quality performance across assigned teams
Build and maintain strong client relationships through consistent communication, responsiveness, and proactive operational support.

Requirements

What you’ll need

Bachelor’s degree in nursing, healthcare administration, or related field
5+ years of experience in Utilization Review or Case Management
2+ years in a leadership role overseeing clinical teams
Extensive knowledge of Utilization Review operations, payer guidelines, and healthcare regulations
Familiarity with healthcare systems, hospital operations, and revenue cycle functions
Expertise in process improvement methodologies and project management principles.

Benefits

Comp & perks

Health insurance
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Utilization ReviewCase Managementprocess improvement methodologiesproject management principles

Soft Skills

coachingmentorshipperformance managementclient relationship managementcommunicationresponsivenessoperational support

Certifications

Bachelor’s degree in nursingBachelor’s degree in healthcare administration