Vice President, Utilization Management

Location: Remote-FL, United States

Salary: $188,900–$359,800 per year

Company

hirify.global provides healthcare services focused on connecting people with the care they need and improving health outcomes.

What you will do

• Plan and execute enterprise medical management utilization programs, processes, and strategic initiatives.
• Lead cross-functional collaboration to evaluate, refine, and advance utilization management strategy.
• Use data-driven decision-making and performance metrics to improve outcomes and reduce costs.
• Develop policies, clinical guidelines, standard operating procedures, and aligned business practices.
• Design innovative operational models in response to healthcare delivery trends and emerging care models.
• Establish service level agreements and lead change management across utilization management functions.

Requirements

• Bachelor’s degree in nursing, a related healthcare field, or equivalent experience.
• 10+ years of experience in managed care, health plans, or provider network organizations.
• Current nursing license required.
• Experience with Managed Medicaid is preferred.
• Master’s degree in nursing or business is preferred.
• Experience ensuring compliance with regulatory requirements and healthcare policies.

Culture & Benefits

• Remote, hybrid, field, and office work schedules are supported.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and paid holidays.
• Flexible work approach and a focus on improving healthcare accessibility and effectiveness.