Director of Group Health in United States at Jobgether
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Job Description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director of Group Health based in United States.
This leadership role is responsible for driving operational excellence, client satisfaction, and financial performance within a high-volume group health services organization. You will oversee end-to-end operations for utilization management programs, ensuring service quality, compliance, and efficiency across multiple client engagements.
You will lead cross-functional teams responsible for delivering timely, accurate, and high-quality clinical review services that directly impact payer and provider outcomes.
The role requires strong leadership across both people and process, with accountability for performance metrics, profitability, and continuous improvement.
You will collaborate closely with medical leadership and operational teams to optimize workflows, strengthen physician networks, and enhance client outcomes.
This is a highly visible position combining strategic oversight with hands-on operational leadership in a fast-paced healthcare services environment.
You will play a key role in shaping team culture, scaling operations, and ensuring long-term client success.
- Lead and oversee the Group Health Operations Management team, ensuring effective execution of utilization management services and operational workflows.
- Drive achievement of key client performance metrics, including turnaround time, quality indicators, peer-to-peer success rates, and overturn rates.
- Manage overall division profitability, including ownership of P&L performance and financial objectives.
- Oversee recruitment, development, and retention of high-performing clinical and operational team members.
- Partner with internal teams to conduct audits, identify process gaps, and implement operational improvements.
- Collaborate with medical leadership to support physician panel development and ongoing clinical alignment.
- Ensure accurate reporting, reconciliation of client outcomes, and resolution of operational issues and escalations.
- Support the integration of technology solutions to improve efficiency, client satisfaction, and service delivery.
- Lead special projects and strategic initiatives aligned with business growth and operational excellence.
- Bachelor’s or Master’s degree preferred; Registered Nurse (RN) required, preferably BSN or higher.
- 5–10 years of experience managing Utilization Management nursing teams within a health plan, IRO, or similar healthcare environment.
- Strong understanding of utilization management standards, guidelines, and healthcare review processes.
- Proven experience leading operational units with accountability for performance, client satisfaction, and financial outcomes.
- Strong leadership skills with experience managing and developing multidisciplinary teams.
- Excellent communication, critical thinking, and organizational skills with the ability to manage deadlines effectively.
- Strong computer literacy and ability to work efficiently in remote, technology-driven environments.
- Ability to work independently while maintaining alignment with broader organizational goals.
- Comprehensive medical, dental, and vision insurance coverage for employees and families.
- Employer-paid basic life insurance, short-term disability, and long-term disability coverage.
- Voluntary benefits including supplemental life insurance, hospital indemnity, critical illness, accident coverage, and pet insurance.
- Generous paid time off to support rest, recovery, and work-life balance.
- 401(k) retirement plan with company match to support long-term financial planning.
- Remote work setup support including equipment (e.g., Apple devices) and media stipend.
- Opportunity to join a high-growth, performance-driven healthcare services organization.
- Exposure to large-scale claims and utilization management operations across multiple healthcare segments.