AVP, Utilization Management

About the role

By embodying our core purpose of customer obsession, driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. The Assistant Vice President, Utilization Management provides senior operational leadership for utilization management programs, supporting enterprise strategies focused on regulatory compliance, clinical documentation integrity, and reimbursement optimization. This role partners closely with clinical, operational, and financial leaders to execute utilization management initiatives, reduce preventable denials, and improve care coordination. The AVP supports the execution of enterprise utilization management strategy, oversees day-to-day operational performance across assigned programs or service lines, and leads managers and senior leaders responsible for utilization review, authorization, and medical necessity processes. This role will include travel, up to 25%.

Responsibilities

• Executes enterprise utilization management strategy aligned with organizational and regulatory requirements
• Oversees operations including prior authorization, medical necessity review, and concurrent review processes
• Ensures compliance with CMS, payer, and state regulatory requirements
• Identifies and mitigates audit, compliance, and reimbursement risks
• Monitors performance metrics including denial trends and utilization efficiency
• Drives performance improvement initiatives based on data analysis
• Collaborates with clinical, case management, and revenue cycle teams to improve documentation and reduce denials
• Supports implementation and optimization of utilization management technologies and workflows
• Leads and develops managers and operational leaders
• Supports succession planning and organizational capability development
• May be required to perform other job-related duties as requested.
• Able to travel up to 25% of the time, any may include occasional international travel
• EDUCATION AND EXPERIENCE
• Bachelor's degree or equivalent combination of education and experience
• Current RN license
• 10+ years of relevant experience including advanced knowledge of utilization management and healthcare reimbursement
• 5+ years of people leadership experience
• Strong executive presence with the ability to project confidence, credibility and authority; able to remain calm & show decisiveness under pressure
• Exhibits strong strategic and analytical skills with the ability to drive operational improvements
• Ability to build and maintain relationships with key internal and external stakeholders
• Ability to effectively lead diverse teams and influence change management in a complex healthcare operations environment
• Effective communication skills with ability to clearly and succinctly convey information and ideas
• Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale.
• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs dictate.
• This position pays between $134,000 - $167,500 based on experience, and is eligible for bonus incentives.
• Join an award-winning company
• Five-time winner of "Best in KLAS" 2020-2022, 2024-2025
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
• Energage Top Workplaces USA 2022-2024
• Fortune Media Best Workplaces in Healthcare 2024
• Monster

Benefits

Additional Information

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" Ensemble Difference Principles and consistently delivering outstanding results.

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