Director - WTS (Healthcare)

Location: Remote, Houston, TX, United States

Base salary: $150,000–$160,000 annually; performance-based bonuses, incentive pay, or commissions may also apply.

Company

hirify.global, part of Capgemini, provides AI-powered intelligent operations and transformation solutions across healthcare, financial services, insurance, logistics, travel, and other industries.

What you will do

• Define and execute the strategy, roadmap, features, and enhancements for utilization management products.
• Translate business, clinical, and regulatory needs into product concepts, requirements, and prioritized backlogs.
• Develop ROI, cost-benefit, and operational business cases and present investment recommendations to senior leadership.
• Drive initiatives from concept through delivery and post-launch optimization in collaboration with IT, clinical, operations, compliance, and finance.
• Optimize legacy utilization management platforms for automation, scalability, usability, compliance, and client performance.
• Define and report KPIs including turnaround time, denial and approval accuracy, cost containment, quality outcomes, and user adoption.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Technology, or a related field.
• 5–8+ years of experience in product management, utilization management, or healthcare operations.
• Strong knowledge of utilization management processes, including prior authorization, concurrent review, and medical necessity review.
• Experience developing business cases and leading product or feature definition.
• Proven ability to manage complex cross-functional initiatives.
• Strong analytical and problem-solving skills.

Nice to have

• Experience with utilization management platforms, care management systems, or health IT solutions.
• Familiarity with CMS, NCQA, URAC, and other regulatory frameworks.
• Experience in Agile or hybrid product environments.
• Clinical background such as RN or LPN, or equivalent experience.

Culture & Benefits

• Full-time employment with medical, dental, and vision insurance.
• Paid time off, holidays, and sick leave.
• 401(k) with company match or another retirement plan.
• Life and AD&D insurance and an Employee Assistance Program.
• Inclusive equal-opportunity workplace with reasonable accommodations available during the application process.

Hiring process

• Submit a resume and optional cover letter through the careers page or by email to talent@healthhelp.com.