Director, Virtual Utilization Review

By embodying our core purpose of customer obsession, driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. The Director of Virtual Utilization Review will serve as a strategic leader focused on driving client partnerships, performance outcomes, and transformational change across people, process, and technology. This position emphasizes strategic oversight, data-driven decision-making, and relationship management rather than day-to-day workflow execution. You will lead complex, multi-client utilization review and utilization management operations while shaping the future of how we deliver value to our partners. This role will include travel, up to 25%.

Job Responsibilities include, but are not limited to:

Strategic Leadership & Client Partnership

• Build strong, trusted relationships with clients and serve as a strategic partner
• Develop a deep understanding of client KPIs and SLAs within the first 60 days
• Identify and execute proactive opportunities to improve performance, satisfaction, and outcomes

Operational & Performance Excellence

• Oversee complex multi-client utilization review and utilization management operations
• Drive measurable improvements in performance, productivity, and SLA attainment
• Lead data-driven decision-making using dashboards and analytics tools

Transformation & Change Management

• Champion adoption of new technologies and investment capabilities
• Lead large-scale change initiatives across people, process, and technology
• Partner cross-functionally to implement process and system improvements

Team Leadership

• Lead, develop, and mentor a large, multi-layered team of 125–175 employees globally
• Manage and empower direct reports including a minimum of 3 leaders
• Foster a high-performing culture aligned with organizational values

Who You’ll Work With

• Direct reports and broader VUR organization
• Clients and external partners
• Cross-functional teams, including Clinical Documentation Improvement (CDI)
• Peer Directors and AVP-level leadership

What Makes This Role Exciting

• Director-level strategic role with significant visibility and impact
• Opportunity to lead a large, global team across multiple geographies
• Exposure to complex healthcare operations in utilization review and management
• Key role in driving technology transformation and innovation
• Strong focus on analytics, performance improvement, and client experience

Experience:

• Bachelor’s degree or equivalent combination of education and experience
• Current RN license
• 2+ years of leadership experience in multi-client utilization review / utilization management operations
• Experience in Revenue Cycle Management (or equivalent healthcare leadership experience)
• Experience managing geographically dispersed teams across the US and international locations
• Demonstrated success in client relationship management and partnership development
• Strategic mindset with experience driving organizational transformation and leading change management initiatives across people, process, and technology
• Data-driven leadership approach, with strong analytical skills; proficiency in Power BI (for dashboard navigation and insights) preferred
• Effective communication skills with the ability to organize and present information clearly and concisely
• Strong technical skills including database and spreadsheet analysis and working knowledge of EMR(s) with front- and back-end understanding
• Experience with project management tools preferred (AHA, Loop, Microsoft Project, or similar)

**This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs dictate**

**This position pays between $101,600 - $145,000 based on experience, and is eligible for annual incentives.**