Director of Utilization Management

Job Description

Job Description

About Lucent Health

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

Company Culture

We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.

Honest

• Transparent Communication : be open and clear in all interactions without withholding crucial information
• Integrity : ensure accuracy in reporting, work outputs and any tasks assigned
• Truthfulness : provide honest feedback and report any issues or challenges as they arise
• Trustworthiness : build and maintain trust by consistently demonstrating reliable behavior

Ethical

Hardworking

Summary

The Director of Utilization Management (UM) and Clinical Quality is responsible for the strategic and operational leadership of the Utilization Management department. This includes ensuring compliance with regulatory and accreditation standards, driving clinical quality improvement, and maintaining optimal performance of UM operations, including nurse and physician reviews, appeals management, utilization-related metrics, and phone and queue management for the team. The Director ensures that utilization practices support appropriate, cost-effective, and high-quality care for members while achieving contractual, operational, and regulatory expectations. The Director of UM and Clinical Quality reports to the Vice President of Clinical Operations.

Responsibilities

Utilization Management Oversight

Appeals and Grievance Management

Clinical Quality & Utilization Metrics

Regulatory & Accreditation Compliance

Leadership & Team Development

Interdepartmental Collaboration

Qualifications

Equal Employment Opportunity Policy Statement

Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.