Director, Utilization Management Operations

CareSource

. Manage and prioritize Utilization Management and related projects, ensuring timely completion and adherence to requirements .

Posted 10/15/2026full-timeRemote • United StatesLead💰 $135,600 - $237,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management, program implementation, and operational workflow development, with a strong focus on improving member outcomes and integrating clinical services. Possesses leadership qualities and the ability to manage projects effectively while engaging stakeholders for organizational alignment.

Highest-signal resume keywords

Utilization Management ExperienceMedical Management OperationsProgram ImplementationStrong Communication SkillsRN Licensure

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Project ManagementData AnalysisRegulatory ReportingOperational Workflow DevelopmentProgram Evaluation

Soft Skills

Leadership QualitiesRelationship BuildingOrganizational SkillsProblem SolvingTime Management

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft ProjectVisio

Certifications & Qualifications

Current RN Licensure

Industry Keywords

MedicaidMedicareManaged CareBehavioral HealthCase Management

About the role

Key responsibilities & impact

Manage and prioritize Utilization Management and related projects, ensuring timely completion and adherence to requirements
Gather and prioritize business requirements for departmental requests, including regulatory reporting
Monitor program performance to identify improvement opportunities and leverage best practices and knowledge sharing
Lead collaboration with clinical teams and stakeholders to ensure coordination and communication
Assist with monitoring legislative and governmental activities and integrating clinical services
Support data-driven efforts to improve member outcomes and experiences
Lead and support readiness activities for new business and program implementation
Develop program documents and operational workflows
Engage stakeholders to ensure organizational alignment
Add services and processes for new lines of business as required
Recruit, develop, and lead key staff
Assist the UM Department with projects and company and department initiatives, including program descriptions, evaluations, policies, procedures, business requirements, contract compliance, and execution
Perform other job-related instructions as requested

Requirements

What you’ll need

Bachelor’s Degree or equivalent years of relevant work experience is required
Minimum of five (5) years medical management operations, leadership, program, or management experience is required
Master’s degree in Health Care Administration and two years of post-degree professional experience is preferred
Minimum of one (1) year Utilization Management experience preferred
Experience implementing programs with focus on integration is preferred
Experience with Medicaid, Medicare, Commercial and Managed Care is preferred
Strong Knowledge of Visio, Microsoft Word, Excel, PowerPoint and Project
Strong communication Skills; written and verbal
Ability to work independently and within a team environment
Strong organizational, time management, analysis, and problem solving skills
Ability to manage a project from start to finish
Strong relationship building skills and leadership qualities
Training and teaching skills/change agent
Ability to think critically and lead with strategy
Comprehensive knowledge base crossing all areas within the Health Services Areas including: Behavioral Health, Case Management, Utilization Management, Integration and Pharmacy
Current, unrestricted RN licensure is preferred
General office environment; may be required to sit or stand for extended periods of time

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Total well-being support
Remote work arrangement
Some travel may be required to fulfill the duties of the role