Senior Director, Utilization Management Operations & Performance
On-site · Pittsburgh, Pennsylvania, United States
Job Summary
Senior Director leading Highmark’s Utilization Management (UM) operations, driving execution and continuous optimization of UM, leveraging Lean Six Sigma and global workforce models to improve quality, speed, and unit cost. Oversees large-scale, cross-functional UM processes with budgetary accountability, partners with Claims, Appeals, Provider Relations, and Member Services, and steers offshore/onshore staffing strategies, automation, and technology-enabled improvements to achieve best-in-class performance and cost efficiency.
Required Qualifications
- 7 years of experience in the Health Insurance Industry, with extensive and proven experience in payer operations management
- 5 years of experience in a management or leadership role
- 5 years of proven, hands-on experience in project management and Lean Six Sigma, OpEx, or similar advanced continuous improvement methodologies at enterprise scale
- 5 years of experience in senior operational leadership within a large-scale operations environment with direct accountability for efficiency, operational performance, and financial delivery
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