Director of Utilization Management
No salary listed
Expert
Bachelor's, Master's
Coral Gables, FL, USA
In PersonBased in the corporate office, with travel required to various center locations.
Medical, Clinical & Veterinary
About the job
Requirements
- A Bachelor of Science in Nursing (BSN) and a valid multistate nursing license are required.
- A master's degree in Nursing, Public Health, or a related field is required.
- At least 10 years of progressive experience in healthcare administration, including at least 5 years in a leadership role in utilization management, case management, or a related field.
- Strong knowledge of utilization management processes, clinical guidelines, and healthcare regulations is required.
- The ability to analyze complex data, identify trends, and develop actionable improvement strategies is required.
- Proficiency in electronic health record (EHR) systems and other healthcare management software is required.
Responsibilities
- Direct the day-to-day operations of the Referrals Department and RN Case Managers to ensure high-quality care and service delivery.
- Provide strategic leadership in optimizing patient referrals, case management practices, and healthcare resource utilization.
- Manage and mentor clinical and administrative staff, fostering a collaborative and patient-centered work environment.
- Develop and implement policies and procedures for effective referral management and case coordination.
- Oversee the utilization review process, ensuring appropriate use of services and adherence to best practices and guidelines.
- Monitor referral patterns and case management outcomes, analyze trends, and recommend process improvements.
- Ensure the organization meets regulatory and accreditation standards related to utilization management.
- Work with clinical teams, including providers and other medical professionals, to promote efficient care coordination and utilization management.
- Serve as a liaison between the Utilization Management team, senior leadership, and other departments.
- Collaborate with external partners, including insurance companies and healthcare networks, to facilitate care transitions and referrals.
- Analyze clinical and financial data to track utilization patterns and ensure efficient use of resources, including the cost reallocation process.
- Report utilization trends, case management outcomes, and potential improvement areas to senior leadership.
- Identify opportunities to reduce unnecessary utilization, improve cost-effectiveness, and enhance patient care outcomes.
- Ensure compliance with healthcare regulations, standards, and internal policies.
- Develop and implement quality improvement initiatives related to case management, referral processes, and overall care coordination.
- Lead and participate in audits, assessments, and reviews related to utilization management and patient care quality.
Desired Qualifications
- Experience working in a primary care setting or with a network of primary care clinics is highly preferred.
- A proven track record of managing referral processes and case management teams, and optimizing resource utilization, is desired.
About the company
Palm Medical Centers provides primary care services for seniors 65+ who have Medicare Advantage plans, across many locations in Central and South Florida. Its approach combines accessible doctors, care coaches, and trained staff to build personal relationships with patients, enabling customized health plans aimed at improving overall well-being. Unlike many clinics, it emphasizes a consistent, friendly “Palm Medical Experience” grounded in compassionate, community-focused care. The company’s goal is to help seniors stay healthier and happier by delivering tailored, easy-to-access primary care with genuine kindness.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Miami, Florida
Founded
2013
Get referred to Palm Medical Centers
See people who can refer or advise you
Simplify's Take
What believers are saying
- Palm added Azle clinics March 1, 2026, widening North Texas reach to nine.
- Palm opened Dade City, Spring Hill, Sanford, and Oviedo clinics during 2025-2026.
- Cristo Rey Miami partnership and hiring show active recruiting and community-based growth.
What critics are saying
- Rapid Texas and Florida expansion strains integration, staffing, and clinic consistency in 2026.
- Medicare Advantage dependence exposes Palm to payer repricing during 2027 contract renewals.
- A major payer exit or quality penalty could crush margins and force a sale.
What makes Palm Medical Centers unique
- Palm serves Medicare Advantage seniors with value-based primary care across 44 locations.
- MBF ownership funds rapid tuck-in acquisitions and de novo clinic launches.
- Brandon Zeman’s growth leadership links clinic M&A, partnerships, and market expansion.
Help us improve and share your feedback! Did you find this helpful?
Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Employee Assistance Program
- Flexible Spending Account
- Health Savings Account/Flexible Spending Account
- Paid Time Off
- Paid Holidays
- 401(k) Retirement Plan
- Relocation Assistance