Executive System Director of Utilization Management
Job in
Morrisville, Wake County, North Carolina, 27560, USA
Listing for:
Case Management Society of America (CMSA) ®
Full Time
position
Listed on 2026-02-01
Job specializations:
-
Healthcare
Healthcare Management, Healthcare Administration
Salary/Wage Range or Industry Benchmark: 60000 - 80000 USD Yearly
USD
60000.00
80000.00
YEAR
Job Description & How to Apply Below
Overview
The Executive System Director of Utilization Management (UM) is a strategic and operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and multiple community-based hospitals and care settings. This role provides enterprise-wide oversight to ensure clinically appropriate level of care, optimal patient flow, regulatory compliance, and effective and efficient management of healthcare resources in alignment with institutional goals.
The Executive Director works with leaders from case management, physician advisors, revenue cycle, medical staff, nursing, and information systems to create a unified and standardized utilization management infrastructure and to deliver high-quality, value-based care across the system.
Responsibilities
Utilization Management – Develop and lead a system-wide UM strategy to ensure consistent application of UM principles across all entities. Establish and enforce enterprise-wide UM policies, procedures, and performance standards. Lead integration efforts across hospitals with varying operational models (community hospitals and academic institutions). Ensure uniform application of care level determinations, medical necessity assessments, and documentation improvement initiatives. Oversee the development and use of a standardized performance dashboard for UM with key statistics impacting the organization and the UM program.Leading People – Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower system-level UM leaders and staff through recruitment, mentorship, and professional development. Foster a culture of ongoing improvement, accountability, and excellence; ensure an inclusive workplace that supports development, cooperation, teamwork, and constructive conflict resolution. Ensure appropriate handling of sensitive information. Improve and reinforce staff performance, staffing, orientation, and training.
Foster collaboration with medical staff, department chairs, hospital leadership, and finance to harmonize UM practices and align with clinical and financial objectives. Lead physician engagement initiatives by developing training for physician advisors and advocating for evidence-based resource utilization.Leading Change – Drive unification of diverse operational models across multiple hospitals and care settings. Initiate and manage the change process, remove barriers, and accelerate adoption. Communicate a compelling vision and need for change; engage stakeholders and secure resources. Model innovation and continuous improvement in organizational performance. Design, execute, monitor, and evaluate improvement initiatives; standardize practices across the system and collaborate with leaders to optimize clinical and financial outcomes within ethical, legal, and regulatory parameters.Results Driven – Implement and optimize technology platforms (e.g., Inter Qual, MCG, EMR integrations) for efficient case review and documentation. Establish key performance indicators to monitor compliance with healthcare regulations and measure UM effectiveness (LOS, pre- and post-claim denial rates, readmissions, payer methods). Identify savings opportunities and deploy strategies to improve resource efficiency. Manage UM budget and financial performance; apply financial concepts and practices to understand overall organizational performance.Qualifications
and Requirements
Education Requirements: Bachelor of Science in Nursing (BSN) from an accredited school with licensure in North Carolina and a Master’s degree in Nursing, Health Care Administration, or related field, or a Master’s degree in Social Work.
Licensure/Certification Requirements: RN or MSW licensure preferred.
Professional Experience Requirements: Minimum of ten (10) years of related experience, with at least seven (7) years of management experience.
Knowledge, Skills, and Abilities: Knowledge and experience with EMR and care management technology, hospital coding/billing, payer contracting, and Revenue…
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