Director, System Utilization Management

Director, System Utilization Management

The Director, System Utilization Management (UM) provides strategic and operational leadership for utilization review, and resource management functions across the health system. This role ensures appropriate use of healthcare services, regulatorycompliance, and optimal reimbursement, across all facilities and service lines. The Director oversees day-to-day utilization review operations, establishes standardized processes and best practices, and drives organizational alignment to promote cost-effective care. Working collaboratively with clinical, operational, and revenue cycle leadership, this position advances performance improvement initiatives, reduces denials, and strengthens financial and regulatory outcomes across the system.

General Duties

• Strategic Leadership
• Regulatory & Compliance Oversight
• Revenue Cycle Integration
• Clinical Operations Oversight
• Data Analytics & Performance Improvement
• Team Leadership & Development

Education Qualifications

• Bachelor's degree in nursing, required (master's preferred).

Experience Qualifications

• 7–10+ years of progressive leadership experience in Utilization Management or Case Management.
• Experience in multi-hospital or system-level leadership preferred.
• Strong knowledge of payer requirements, CMS regulations, and accreditation standards.
• In depth working knowledge and experience of the EPIC Electronic Health Record System Utilization Management workflows, WQs and data reporting capabilities.

Licenses and Certifications

• Active RN license (if clinical background).
• Certification in Case Management and/or Utilization Management preferred.

Work Shift

Days (United States of America)

LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little "come on in" attitude is the foundation of LCMC Health's culture of everyday extraordinary.

Your extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems – it's all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do

You are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Simple things make the difference.

1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.

2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.

3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.

4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.