Director, Utilization Management Operations (Medtech)

TL;DR

Director, Utilization Management Operations (Medtech): Leading clinical and non-clinical teams to optimize utilization management processes and ensure timely, accurate care decisions with an accent on scalability and operational efficiency. Focus on leveraging AI-enabled tools, managing offshore partnerships, and ensuring strict regulatory compliance within the Medicare Advantage landscape.

Location: Must be based in the 50 U.S. states. Role is fully remote with semi-annual travel required to a company office.

Salary: $182,000 - $248,000 / year

Company

hirify.global is an all-in-one healthcare company dedicated to improving the health and well-being of older Americans by providing integrated, compassionate care.

What you will do

• Provide leadership and professional development to clinical and non-clinical teams.
• Manage offshore vendor partnerships to ensure performance metrics and workflow alignment.
• Evaluate and prioritize technology and AI-driven improvements for internal platforms.
• Partner with Data Science and Engineering to develop and monitor operational KPIs.
• Ensure regulatory and compliance excellence by translating complex guidance into operational workflows.
• Collaborate with Provider Network and Pharmacy UM teams to minimize care barriers.

Requirements

• Must be located within the 50 U.S. states.
• Demonstrated experience leading large clinical teams.
• Track record of transforming complex operational challenges into scalable business processes.
• Data-driven mindset with experience or interest in leveraging AI-enabled tools.
• Ability to master complex regulatory guidance and incorporate it into daily operations.
• Exceptional written and verbal communication skills.

Nice to have

• Prior experience in Utilization Management processes and medical necessity review.
• Familiarity with Medicare Advantage operations and CMS guidelines.
• MBA or advanced degree in health administration or finance.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• 401K program.