Exl Service

Director of UM

Job Location US-FL-Tampa
Regular Full-Time
Job Code


EXL (NASDAQ: EXLS) is a leading operations management and analytics company that designs and enables agile, customer-centric operating models to help clients improve their revenue growth and profitability. Our delivery model provides market-leading business outcomes using EXL’s proprietary Business EXLerator Framework™, cutting-edge analytics, digital transformation and domain expertise. At EXL, we look deeper to help companies improve global operations, enhance data-driven insights, increase customer satisfaction, and manage risk and compliance. EXL serves the insurance, healthcare, banking and financial services, utilities, travel, transportation and logistics industries. Headquartered in New York, New York, EXL has more than 26,000 professionals in locations throughout the United States, Europe, Asia (primarily India and Philippines), South America, Australia and South Africa. For more information, visit www.exlservice.com.




JOB SUMMARY: The Senior Director (SD) of Utilization Management & Physician Review Services has overall responsibility for driving the development and implementation of operational and functional support for the highest quality of utilization management for Health Integrated.  This position will oversee Medical, Behavioral and Physician Review Services including prospective, level of care, retrospective, referral management, triage, and UM services in all HI locations and across all clients. The SD directs and coordinates UM operations to ensure compliance with product development, policy / procedures and regulatory standards, while leading these departments to a market-leading level of UM performance. This position ensures that staff are trained, supervised, reviewed and have the oversight to deliver the highest levels of internal / external client services.  The SD will assist in working with the appropriate departments to: a) implement new UM information systems; b) coordinate operations across the operational and account servicing departments; and, c) support development of product collateral, new business presentations and product launches. 


Job Performance/Responsibilities:


  • Directs all Medical and Behavioral Health Utilization Management and Physician Review Services
  • Provides day-to-day assistance and supervision of all staff involved in triage and referral activities
  • Assists in the licensing process of Utilization Management and Physician Review Service programs;
  • Interviews, selects and supervises the hiring of UM and PRS staff;
  • Develops an appropriate CQI process for the Utilization Management program;
  • Evaluates the output and performance of Medical and Behavioral Health Utilization Management staff and Physician Review Service Staff
  • Assists the SVP Operations in plans for growth and staffing management
  • Prepares the annual Utilization Management and Physician Review Service plans and / or enhancements, goals, objectives and communicates this to the Utilization Management and Physician Review Service staff the process and outcomes;
  • Assists in new utilization management and physician review service product development;
  • Provides input and direction on systems issues and enhancements and is responsible for ensuring the successful implementation of any new or upgrades to the HI UM management systems / technology
  • Responsible for developing and implementing utilization and PRS policies and procedures and ensuring operational procedures and work flows support these UM Policies and Procedures
  • Develops and maintains job staff descriptions and ensures the smooth operation of the UM department and its interactions with other HI departments
  • Assist with development of education / training programs and ensuring that staff training is up-to-date
  • Ensures that all regulatory and accreditation standards are met and implemented in the utilization management and physician review services
  • Responsible for the Program Description and annual evaluation;
  • Responsible for coordination of the Utilization Management and Physician Review Service Programs with other Health Integrated Committee interactions, (e.g. Quality Committee, client committees, etc.)
  • Develops strong working relationships with directors, product managers and internal staff for a cooperative sharing of ideas and support;
  • Assists in developing the reporting capabilities of the utilization management services for internal and external sites with all departments;
  • Provide required reports as indicated and participates in special projects as needed;
  • Assists in resolving client / health plan, provider, and / or member / patient complaints;
  • Clinical oversight, consults and seeks advice for licensed physician and / or medical director with expertise appropriate to the type of services being managed; and
  • Readily available to answer questions of the non-clinical staff and shall ensure that non-clinical staff is performing within the scope of the non-clinical role.
  • Such other duties and responsibilities that may be assigned from time to time.

Customer Services-Internal:


  • Supports a positive working environment; identifies and resolves potential personnel / peer problems and issues proactively;
  • Identifies utilization management policy/procedural problems, issues and/or concerns as they arise;
  • Monitors and reports to UM/QI any issues or concerns related to utilization management/physician review service/quality of care, using utilization management procedures;
  • Maintains a courteous and professional attitude when working with all staff members and the management team; and
  • Actively participates in UM/PRS team meetings.





  • Licensed healthcare professional (RN, LCSW, LMHC, LMFT, or PsyD) with current, unrestricted license to practice as a health professional in a state or territory of the United States required. Additional certification in specialty fields or other advanced certification is desirable.  Bachelor’s degree preferred in a health science, Master’s degree preferred.



  • A minimum of 5 to 7 years’ progressive experience leading UM, quality management, discharge planning within a risk bearing entity is required, with experience with criteria systems (e.g. Milliman, InterQual, etc.). Three or more years of direct care experience or in an inpatient unit or outpatient program management highly preferred.



  • A proven track record deploying a strong and highly-effective UM review team is required.
  • Ability to develop and execute product and program implementation plans, including identification of resources and budget required.
  • Proven track record implementing a new clinical care system highly desirable.
  • Proven ability to analyze the effectiveness of products and programs, identify problems and take prompt corrective actions when required.
  • Excellent communication skills, both verbal and written along with strong computer (e.g. Word, Excel, Access, PowerPoint, etc.) skills
  • Ability to participate in product development / improvement activities across multiple clients and company departments / functional areas.
  • Strong administrative and analytic skills to identify / correct issues, report progress and successfully implement change.
  • Strong knowledge of managed care, cost containment, risk, utilization management and physician review services.
  • Call center knowledge desirable
  • Knowledge of managed care, utilization management and physician review services program planning, design and implementation.

EEO Statement



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