Job Description

Job Description

Director of Care Management and Utilization Review- Multi-System

Location: Pacific Northwest

Health System Scope: Oversight of 2 hospitals | 500+ licensed beds

Compensation: $150,000 – $230,000 base salary

Relocation Assistance: Available

Opportunity Overview

We are partnering with a large, integrated hospital system in the Pacific Northwest to identify a Director of Care Management and Utilization Review . This is a high-impact leadership role overseeing care management and utilization review operations across multiple hospitals, serving as a strategic connector between clinical teams, physicians, payers, and community partners.

This leader will drive seamless transitions of care from pre-admission through discharge, advocate for complex patient populations, and ensure the appropriate, efficient use of healthcare resources through evidence-based medical review and regulatory compliance.

This opportunity is ideal for an accomplished RN leader who thrives at the intersection of clinical excellence, operational performance, and mission-driven leadership. You will influence system-level outcomes, strengthen physician partnerships, mentor high-performing teams, and use data and systems thinking to continuously improve quality, patient experience, and throughput.

Position Overview

In this role, you will serve as:

• Master Coordinator: Direct and facilitate care management processes to ensure high-quality patient care and operational efficiency
• Champion of Continuity and Care Coordination: Ensure consistent clinical outcomes, advocate for patients, and manage resources to reduce fragmentation across the care continuum
• Communication Facilitator: Foster strong collaboration among physicians, nurses, interdisciplinary teams, payers, and external partners
• Cultural Advocate: Promote culturally and religiously sensitive care across diverse patient populations

Essential Functions

• Lead teams in alignment with the organization’s Mission, Vision, and Core Values
• Develop and sustain a comprehensive departmental customer satisfaction program
• Recruit, develop, coach, and retain high-performing care management and utilization review staff
• Ensure compliance with infection control, risk management, confidentiality, and regulatory standards
• Foster a respectful, inclusive environment sensitive to cultural and religious diversity
• Ensure adherence to safety and security policies and procedures
• Oversee patient-centered care delivery across all age populations including neonates through older adults
• Develop and maintain departmental policies aligned with organizational, legal, and community standards
• Support departmental goal setting aligned with system-wide strategies
• Participate in annual budget planning and cost-effective resource utilization
• Oversee admission and discharge processes, including alternatives to non-qualifying inpatient admissions
• Build and maintain strong collaborative relationships with physicians
• Chair and lead the Utilization Management Committee, monitoring trends and outcomes
• Oversee contracted services and external partners to ensure quality and performance
• Establish and maintain referral agency relationships to support timely and effective patient discharges

Qualifications

• Bachelor’s Degree in Nursing required; Master’s Degree preferred
• Active Registered Nurse background with at least 2 years of acute care clinical experience
• Minimum of 3 years of leadership experience in care coordination or care management
• Utilization review experience strongly preferred
• Proven ability to work independently while leading complex teams and initiatives
• Demonstrated strength in systems thinking, data-driven decision making, and operational problem solving

Compensation and Benefits

• Competitive base salary range of $150,000 – $230,000
• Relocation assistance available
• Comprehensive benefits package including:
• 401(k) savings plan with employer match
• Medical, dental, and vision coverage
• Life and disability insurance
• Paid parental leave, vacation, holidays, and sick time
• Voluntary benefits and robust well-being resources

Why This Role

This is a rare opportunity to lead care management and utilization review at scale within a mission-driven health system. You will have executive visibility, system-level influence, and the opportunity to shape the future of care delivery while improving patient outcomes, experience, and operational performance.

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