Director, Utilization Management

Location: Remote in Florida; applicants must reside in Florida

Salary: $121,500–$224,900 per year

Company

hirify.global provides healthcare services focused on improving access to care and supporting healthier outcomes for members and communities.

What you will do

• Direct daily utilization management operations, including timeliness, quality, performance outcomes, provider interactions, and regulatory compliance.
• Lead team performance, process improvement, career development, onboarding, hiring, and training.
• Establish and maintain utilization management policies and procedures aligned with corporate, state, and NCQA standards.
• Analyze utilization trends, patterns, and impacts, and present recommendations to senior leadership.
• Develop utilization management strategies and oversee department budget components in collaboration with senior leadership.
• Lead change initiatives and manage cross-functional work in a matrixed environment with strict deadlines.

Requirements

• Must reside in Florida.
• Bachelor’s degree and 7+ years of related experience, including prior management experience, or equivalent applicable experience.
• Leadership experience and a strong background in long-term care utilization management, Medicaid managed care, LTSS/LTC, prior authorization, and care management operations.
• Knowledge of industry regulations, policies, and standards.
• RN state licensure and/or compact state licensure preferred.
• Four or more years of management experience preferred.

Culture & Benefits

• Remote, hybrid, field, and office work schedules are supported, subject to role requirements.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Work focused on improving healthcare access and member outcomes.