Job Description
This role is fully remote and must be located within the 50 U.S. states. Standard working hours are in Eastern Timezone. Semi-annual travel may be required to a Devoted office for on-site work.
A bit about this role:
We are seeking a curious, operationally minded leader to serve as Director, Utilization Management Operations. Reporting to the Vice President of Health Services, you will lead the teams behind our administrative work: a large onshore and offshore team of UM Administrative Coordinators who manage intake, outreach, notifications, and follow-up. You will also hold dotted-line accountability for monitoring and ensuring the success of our Part B medical authorization turnaround times (TAT).
This role is for someone who is energized by a complex process: someone who wants to unravel it, reimagine it, and lead the build of something simpler, faster, and more consistent. You will have significant influence over the roadmap for Orinoco, our internal technology platform, and an integrated AI engine to put to work. This role will help pave the way towards realizing the next generation of our UM program, driving improvements in effectiveness, efficiency, and experience for our members and provider partners.
Your Responsibilities and Impact will include:
- SLA & Timeliness Ownership: Own SLA performance for the administrative steps that support authorization review across UM, delivering consistent, predictable performance at a meaningfully lower cost. Hold dotted-line accountability for Part B medical authorization turnaround times (TAT), partnering with the clinical leaders of that team to monitor performance, surface risks early, and remove administrative barriers to on-time decisions.
- Process Reimagination: Map our administrative processes end to end, including auth intake, requests for additional clinical information, facility census checks, member and provider notifications, and member follow-up, and lead their redesign for speed, consistency, and simplicity.
- Technology & AI Leadership: Partner with Product and Engineering to shape the Orinoco roadmap so that process and technology evolve together. Put our integrated AI tools to work to remove manual effort, so our administrative capacity no longer has to grow at the same rate as our membership.
- Build for Measurement: Design processes that are highly measurable and transparent by default. Partner with Data Science to define and monitor the KPIs that matter, including timeliness, cost per authorization, quality, and provider experience, and use them to drive decisions and continuous improvement.
- People & Vendor Leadership: Lead and develop a team that includes approximately 50 onshore UM Administrative Coordinators and their leaders. Manage our offshore vendor partnership, which supports more than 250 administrative team members, holding it to clear performance standards while building a shared culture of ownership and care.
- Provider & Member Experience: Partner with the Provider Network team to understand what providers and facilities need from this process, and build it in. Design every touchpoint, from outreach to notifications to follow-up, with the humans on the other end in mind.
- Cross-Functional Partnership: Work closely with the Senior Director of UM, who owns end-to-end authorization performance, along with the UM Medical Directors, Compliance, Provider Network, Data Science, and Engineering teams to keep the operation aligned and consistently audit-ready.
Required skills and experience:
- Mission & Heart: A genuine commitment to treating members like family, and a belief that operational excellence and empathy belong together.
- Proven Operator at Scale: A track record of leading high-volume operations that deliver consistent SLA performance.
- Builder Mindset: Experience taking a complex, multi-step process apart and leading the build of a simpler, more scalable one, rather than only maintaining what exists. You are naturally curious and ask why a step exists before deciding how to improve it.
- Metrics-Oriented: You build for measurement, are comfortable working deep in the workflows and the data, and use both to drive decisions and hold teams and partners accountable.
- Technology & AI Curiosity: Experience partnering with product and engineering teams, and genuine excitement about using AI-enabled tools to transform how work gets done.
- Vendor Management: Experience managing vendor partners against clear performance and quality standards.
- Communication: Exceptional written and verbal communication skills, with the ability to distill complex problems into actionable updates for leadership and stakeholders.
- Education: Bachelor’s degree required.
Desired skills and experience:
- Healthcare Operations: Experience in payer operations, utilization management, claims, provider revenue cycle, or a similar high-volume healthcare environment. Prior UM experience is not required.
- Medicare Advantage Familiarity: Understanding of Medicare Advantage operations and CMS requirements.
- Advanced Degree: MBA or advanced degree in health administration or finance is a plus.
- MBA or advanced degree in health administration or finance is a plus.
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Salary range: $182,000 - 247,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
