Apply Now
Position: Utilization Management Director
Duration: 6 month Contract to Hire
Location: Remote
Position Summary:
The Utilization Review Director – Prior Authorization leads the strategy and operations of the prior authorization function for a health plan, ensuring timely, compliant, and evidence-based medical necessity reviews. This role drives efficiency, oversees clinical and non-clinical review teams, and partners cross-functionally to support utilization management goals across all lines of business.
Key Responsibilities:
-Lead daily operations of the prior authorization unit, ensuring compliance with NCQA, CMS, and state regulatory standards.
-Oversee clinical decision-making processes using evidence-based guidelines (e.g., GuidingCare, MCG, InterQual).
-Manage and mentor review teams, including RNs and support staff, to meet performance and turnaround targets.
-Partner with Medical Directors, Claims, Provider Relations, and IT to optimize workflows and improve provider and member experience.
-Monitor KPIs, identify trends, and implement process improvements to reduce unnecessary utilization and denial rates.
-Support audit readiness, appeals, and regulatory reporting.
-Evaluate and implement technology solutions for automation and efficiency.
Qualifications:
-RN license required (compact licensure preferred); BSN required, MSN or MHA preferred.
-7+ years in utilization management within a health plan; 3+ years in a leadership role.
-Deep knowledge of prior authorization processes, UM regulatory requirements, Texas regulatory requirements, and managed care operations.
-Proficiency in UM platforms (e.g. GuidingCare).
-Strong leadership, communication, and analytical skills.
Utilization Management Director Remote, OR
For over 16 years, Medasource has established and maintained relationships that are designed to meet your IT staffing needs. Whether it’s contract, contract-to-hire, or permanent placement work, we customise our search based upon your company’s unique initiatives, culture and technologies. With our national team of recruiters placed at 21 major hubs around the nation Medasource finds the people best-suited for your business. When you work with us, we work with you. That’s the Medasource promise.
Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.
Benefits & Perks:
Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.
Pay Disclaimer:
The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.
JO-2508-174537