Director Utilization Management

Job Description:

Director Utilization Management

Job Details

Job Location Remote - Corp - Tustin, CARemote Type Fully RemotePosition Type Full TimeJob Shift DayJob Category Executive

Job Summary

Are you passionate about building scalable, compliant operations that deliver real impact? We’re looking for a Director of Utilization Management (UM) Operations to lead the day-to-day performance and continuous improvement of our UM Department.

In this role, you’ll be responsible for ensuring operational excellence through effective UM workflow execution, UM inventory management, and internal/external team engagement. You'll oversee service level agreement adherence, drive process efficiency, and support audit readiness—while ensuring our operations remain aligned with regulatory standards and client-specific requirements.

You’ll partner closely with Clinical, Compliance, IT, Claims, and other cross-functional teams to deliver timely, high-quality service across all UM activities. From automation and staffing strategies to policy oversight and performance reporting, you’ll play a critical role in transforming how we deliver utilization management at scale.

If you thrive in compliance-driven environments, know how to balance execution with strategy, and are passionate about delivering results through collaboration—we’d love to connect with you.

What You'll Do:

• Direct the UM Operations team to ensure adherence to service level agreements (SLAs) at both corporate and client levels.
• Monitor UM inventory and partner with internal teams to distribute work effectively and optimize resource utilization.
• Develop, maintain and enforce UM workflows, policies and procedures, and Policy Explanation Codes (PECs) to ensure compliance with regulatory and client-specific requirements.
• Analyze and improve operational processes to enhance efficiency, reduce errors, and streamline UM processes.
• Lead automation initiatives and optimize the use of UM technology platforms to reduce manual work and increase scalability.
• Identify and implement best practices and standardize procedures across the UM team to drive consistency and quality.
• Set performance expectations and KPIs; monitor progress and coach staff to meet productivity, accuracy, and timeliness goals.
• Collaborate with Analytics, IT, and reporting teams to develop dashboards and performance tools, and forecasting models.
• Ensure operational compliance with federal/state regulations, client contracts, and accreditation standards (such as CMS, NCQA, URAC).
• Support audit readiness and provide timely responses to external and internal audits, reviews, and corrective action plans (CAPs).
• Serve as the operational lead for UM on cross-departmental projects, system implementations, and strategic initiatives.
• Partner with Clinical, Provider Relations, Claims, Quality, Member Services, Compliance and other teams to resolve issues and drive operational improvements.
• Analyze UM trends and recommend changes to proactively address issues, enhance efficiency, including opportunities for process automation and auto-adjudication.
• Review case files for accuracy and participate in interviews or presentations with clients, auditors, or regulatory agencies.
• Evaluate and update processes to reflect changing business needs, regulatory updates, and client requirements.
• Assess training needs and implement cross-training programs to ensure team flexibility and maximize available resources.
• Develop and support cost containment strategies aligned with company objectives.
• Collaborate with leadership to review progress toward goals, identify needs, and align operations with corporate strategy.
• Prepare operational, productivity, and performance reports with actionable insights and recommendations.
• Establish, monitor, and maintain production and quality goals across all UM functions.
• Stay informed on federal and state regulatory changes and industry trends to guide operational planning.
• Assist with ad hoc projects, new initiatives and process integration efforts as needed.
• Perform other duties as assigned.

What You Bring:

• Bachelor’s degree in Business, Healthcare Administration, or a related field (Master’s preferred).
• 10+ years in healthcare operations, Dental Plans Operations, or Utilization Management role, including 5+ years in a leadership role overseeing UM or similar function.
• Strong operational and process management skills.
• Results-driven with a focus on continuous improvement.
• Existing experience in Medicaid/Medicare Audits within the scope of Utilization Management preferred.
• Excellent organizational, analytics, and communication skills.
• Ability to manage in a fast-paced compliance-driven environment.
• Proven leadership and team-building abilities.
• Intermediate Level proficiency with Microsoft Office tools (Word, Excel, Outlook, PowerPoint).
• Effective conflict management skills.
• Ability to drive strategic direction.
• Decision-making skills, planning skills. detail oriented, and attentiveness.

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.

• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP) to support mental health and well-being.

• Generous vacation and sick leave policies, with the ability to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Remote or hybrid work options available for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $150,000 - $180,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. 

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. 

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.