Remote opportunity at
Integra PartnersDirector of Utilization Management
Integra Partners is currently hiring a remote Director of Utilization Management to lead both clinical and non-clinical teams within a managed care setting. Founded in 2005,…
Career Tools
About This Role
Integra Partners is currently hiring a remote Director of Utilization Management to lead both clinical and non-clinical teams within a managed care setting. Founded in 2005, the organization serves as a durable medical equipment, prosthetic, and orthotic supplies network administrator, working to connect payers, providers, and members while enhancing in-home healthcare access. In this position, the professional will oversee utilization management programs, guide strategic growth, and operationalize services for health…
Job Description
Integra Partners is currently hiring a remote Director of Utilization Management to lead both clinical and non-clinical teams within a managed care setting. Founded in 2005, the organization serves as a durable medical equipment, prosthetic, and orthotic supplies network administrator, working to connect payers, providers, and members while enhancing in-home healthcare access. In this position, the professional will oversee utilization management programs, guide strategic growth, and operationalize services for health plan clients.
This role suits an experienced healthcare leader who excels in team management, compliance, and cross-departmental collaboration. Key duties involve designing utilization review policies alongside the Chief Medical Director, managing prior authorization workflows and appeals, driving quality improvement initiatives, and maintaining NCQA certification. The successful candidate will also serve as a key resource for client-facing activities, help configure medical management software, and build scalable staffing models to support future business expansion.
The employer operates with a remote workforce across multiple states, including Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Integra Partners offers comprehensive benefits, such as medical, dental, and vision coverage, a 401(k) program with company match, paid time off, and annual bonus opportunities. Equal opportunity policies apply to all applicants.
Responsibilities
- Develop and maintain Utilization Review Plan policies and procedures
- Partner with the Chief Medical Director to establish and review benefit and medical necessity decision criteria
- Supervise clinical and non-clinical staff to guarantee prompt processing of prior authorizations and appeals
- Execute quality improvement activities, conduct audits, and handle annual IRR testing
- Collaborate with executives and management to align the utilization management program with corporate initiatives
- Take part in the Quality Improvement Committee and Utilization Management Committee
- Coordinate with Account Managers to satisfy contractual delegated activities and client performance standards
- Represent the utilization management team during business development and review sessions
- Implement technology solutions across the department and configure medical management software
- Oversee the execution of workplans required to maintain NCQA certification
- Design and scale a flexible staffing model as business needs evolve
Requirements
- Minimum of 10 years of utilization management management experience in a managed care environment
- Experience leading and managing clinical and non-clinical personnel
- Background with utilization management NCQA or URAC certification and accreditation
- Strong analytical skills and clinical knowledge for assessing medical records and spotting trends
- Effective verbal and written communication abilities
- Interpersonal proficiency to build cooperative working relationships
Qualifications
- Bachelor’s degree in a relevant specialty area
- Current certification or license to perform utilization review in applicable states
Core Skills
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this is a remote role seeking candidates located in Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
What is the salary for the Director of Utilization Management?
The annual salary for this position is $160,000, and it includes eligibility for an annual bonus program.
What experience is required for this job?
Applicants must have a minimum of 10 years of utilization management management experience in a managed care setting, alongside experience managing clinical and non-clinical staff and working with NCQA or URAC certification.
What education is preferred?
A bachelor’s degree in an area of specialty is preferred for this position.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.
Related Jobs