Healthcare Operations Director

Role OverviewThis position focuses on applying deep experience in utilization management and case management to assess complex clinical review workflows, care coordination processes, and medical necessity decisions across healthcare operations.

Key ResponsibilitiesExamine medical necessity findings, clinical review cases, and utilization management recommendations for accuracy and consistency.Assess decisions related to admissions, continued stays, discharge planning, and level of care using approved clinical standards.Assist with physician advisor activities, peer-to-peer review coordination, and denial management workflows.Review care coordination and transition-of-care processes and identify opportunities to strengthen operational performance.Offer structured input on clinical review deliverables, compliance expectations, and utilization management procedures.Candidate ProfileMust hold an active RN or physician license, along with strong hands-on experience in utilization management, case management, or clinical review.Should have experience directing utilization management, care coordination, or case management operations.Working knowledge of InterQual, MCG, Milliman, or similar clinical review tools and standards is required.Should understand medical necessity reviews, observation status rules, and payer-specific requirements.Strong skills in analysis, documentation review, and communication with stakeholders are important.Compensation and Work ArrangementThe contract pays $100 to $150 per hour. This is a fully remote, flexible independent contract engagement. The project is ongoing and based on project needs.

Application NotesSelected candidates will be reached out to with further steps after the initial review.

ResponsibilitiesExamine medical necessity findings, clinical review cases, and utilization management recommendations for accuracy and consistency.Assess decisions related to admissions, continued stays, discharge planning, and level of care using approved clinical standards.Assist with physician advisor activities, peer-to-peer review coordination, and denial management workflows.Review care coordination and transition-of-care processes and identify opportunities to strengthen operational performance.Offer structured input on clinical review deliverables, compliance expectations, and utilization management procedures.

RequirementsMust hold an active RN or physician license, along with strong hands-on experience in utilization management, case management, or clinical review.Should have experience directing utilization management, care coordination, or case management operations.Working knowledge of InterQual, MCG, Milliman, or similar clinical review tools and standards is required.Should understand medical necessity reviews, observation status rules, and payer-specific requirements.Strong skills in analysis, documentation review, and communication with stakeholders are important.

Perks & benefitsHourly compensation in the range of $100 to $150.Fully remote working arrangement.Flexible independent contract setup.Ongoing project-based engagement. Role OverviewThis position focuses on applying deep experience in utilization management and case management to assess complex clinical review workflows, care coordination processes, and medical necessity decisions across healthcare operations.

Key ResponsibilitiesExamine medical necessity findings, clinical review cases, and utilization management recommendations for accuracy and consistency.Assess decisions related to admissions, continued stays, discharge planning, and level of care using approved clinical standards.Assist with physician advisor activities, peer-to-peer review coordination, and denial management workflows.Review care coordination and transition-of-care processes and identify opportunities to strengthen operational performance.Offer structured input on clinical review deliverables, compliance expectations, and utilization management procedures.Candidate ProfileMust hold an active RN or physician license, along with strong hands-on experience in utilization management, case management, or clinical review.Should have experience directing utilization management, care coordination, or case management operations.Working knowledge of InterQual, MCG, Milliman, or similar clinical review tools and standards is required.Should understand medical necessity reviews, observation status rules, and payer-specific requirements.Strong skills in analysis, documentation review, and communication with stakeholders are important.Compensation and Work ArrangementThe contract pays $100 to $150 per hour. This is a fully remote, flexible independent contract engagement. The project is ongoing and based on project needs.

Application NotesSelected candidates will be reached out to with further steps after the initial review.

ResponsibilitiesExamine medical necessity findings, clinical review cases, and utilization management recommendations for accura