Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Director, Behavioral Health Utilization Management (UM) Operations and Product Development is responsible for ensuring evidence-based, regulatory-compliant, and cost-effective UM practices while driving Behavioral Health product design, benefit optimization and clinical program innovation. This leader will own the end-to-end product lifecycle for UM systems and workflows, including prior authorization, concurrent review, medical necessity determination, documentation integrity, regulatory alignment, and operational enablement. The Senior Director partners cross functionally with Product, Network, Quality, Compliance, Finance and Analytics to align the UM strategy with enterprise goals producing quality outcomes. The role requires deep domain expertise in behavioral health and managed care operations, combined with solid execution discipline in complex, regulated environments.

Primary Responsibilities:

• Product Strategy & Roadmap Execution
  • Define and execute product strategy for Utilization Management platforms in alignment with enterprise objectives
  • Develop and maintain a multi-quarter roadmap focused on efficiency, clinical integrity, scalability, and user experience
  • Drive continuous improvement initiatives to enhance member and provider experience and reduce administrative burden
  • Translate regulatory, clinical, and operational requirements into structured product initiatives
  • Establish and monitor KPIs tied to turnaround time, denial rates, rework, productivity, and quality outcomes
  • Drive data-informed decision making across UM and product teams
• Workflow & Platform Optimization
  • Lead redesign and optimization of UM workflows, including prior authorization, concurrent review, discharge planning, and appeals
  • Drive automation and digitization initiatives to reduce manual processes and improve clinical consistency
  • Partner with Engineering to ensure disciplined product development, release management, and system reliability
  • Ensure interoperability with claims, case management, provider portals, and external partner systems
  • Leverage predictive analytics to identify utilization trend drivers
• Regulatory & Clinical Alignment
  • Ensure product capabilities support NCQA, URAC, CMS, and state regulatory requirements
  • Partner with Compliance and Clinical teams to maintain audit readiness and policy-to-system alignment
  • Build governance processes for ongoing regulatory updates and workflow changes
  • Ensure UM policies comply with federal and state regulations including accreditation standards
• Operational Partnership & Change Management
  • Partner with product leadership to design and optimize Behavioral Health benefits across Medicaid, Medicare and Commercial lines of business
  • Drive adoption of new tools and workflows through structured implementation plans
  • Monitor post-implementation performance and lead continuous improvement cycles
  • Ensure frontline clinician feedback is incorporated into product evolution
• Team Leadership
  • Lead and mentor Directors, Managers and Clinical supervisors within Behavioral Health UM
  • Establish disciplined product management practices, including documentation standards, prioritization frameworks, and release governance
  • Promote a culture of accountability, collaboration, and clinical excellence
  • Serves as enterprise subject matter expert on Behavioral Health utilization strategy

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 8+ years of experience in healthcare product management or healthcare operations leadership
• Extensive experience in Utilization Management within behavioral health or managed care
• Experience working in regulated, multi-state healthcare environments
• Deep understanding of medical necessity criteria, authorization workflows, and regulatory requirements
• Demonstrated success managing complex clinical operations platforms
• Proven solid analytical skills with the ability to define metrics and drive measurable improvement
• Proven ability to lead cross-functional initiatives in matrixed organizations

Preferred Qualifications:

• Advanced degree (MBA, MHA, MPH, or related field)
• RN/LCSW
• 5+ years leading a UM team
• Experience in behavioral health managed care
• Experience implementing automation or analytics tools within UM workflows
• Exposure to value-based care models and performance-based contracts

Leadership Competencies

• Operationally disciplined with solid execution focus
• Clinically informed decision-making
• Systems thinker with ability to manage complexity
• Collaborative and influential across clinical and technical stakeholders
• Data-driven and outcome-oriented
• Change agent with solid stakeholder management skills

Scope & Impact
This role directly impacts:

• Authorization turnaround times
• Clinical consistency and quality
• Regulatory compliance performance
• Operational efficiency and cost management
• Provider and member experience

The Senior Director will play a critical role in transforming Utilization Management into a scalable, technology-enabled capability that supports enterprise growth and clinical excellence.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 to $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Requisition #: 2363706

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Requirements