Director of Health Services

OverviewDirector of Health Services — Miami, FL. Our client is seeking an experienced, Senior Director (or Executive Director) of Health Services to lead their Health Services department. This role requires a proven track record in Medicare Advantage health plans with strong case management expertise. The successful candidate will oversee a team of 25 professionals involved in case management and concurrent review, ensuring efficient operations, optimizing resources, and maintaining high quality member care. This person must be an RN licensed in Florida to be considered.Key ResponsibilitiesLead, plan, and manage the Health Services department to maximize productivity and control costsCoordinate with providers, members, and internal teams to facilitate optimal care deliveryOversee case management and utilization review activitiesEnsure compliance with Medicare Advantage guidelines and standardsUtilize data analytics to drive performance improvements and operational excellenceQualificationsCurrent, valid Florida Registered Nurse (RN) license requiredGraduate of an accredited School of NursingMinimum 5 years clinical nursing experienceMinimum 8 years of Utilization Management and/or Case Management experience within a health plan environmentMinimum 5 years leadership/management experience (not nurse supervisor roles)Deep knowledge of utilization review, medical terminology, care levels, treatment modalities, statutes, and healthcare delivery modelsExperience working specifically with Medicare Advantage populationsProven organizational skills, time management, and ability to juggle multiple prioritiesStrong data and analytics proficiencySeniority levelDirectorEmployment typeFull-timeJob functionHealth Care ProviderIndustriesHospitals and Health Care, Public Health, and Health and Human Services #J-18808-Ljbffr

Created: 2025-10-06