10 utilization management experts

Experience: Director, Utilization Management · Mass General Brigham Health Plan

Former Director, Utilization Management at Mass General Brigham Health Plan (2020–2023), Manager, Utilization Management there (2019–2020) and Supervisor, Utlization Management there (2016–2019). The profile describes managing daily operations of utilization review in the supervisor role. Also former Regional Care Manager at the same health plan (2013–2016).

Experience: Director, Behavioral Health UM · Sentara Health

Director, Behavioral Health UM at Sentara Health since February 2024, where the profile describes revamping the Behavioral Health Utilization Management department structure with specialty area reviews, secondary review protocols and AI-driven automation for approvals. Former Regional Director of Utilization Management at Kaiser Permanente (2020–2024) and Director of Utilization Management at Magellan Health (2018–2020).

Experience: Director of Utilization Management · Arkansas Blue Cross and Blue Shield

Director of Utilization Management at Arkansas Blue Cross and Blue Shield since July 2023, a role the profile says leads the utilization review team and makes sure policies and procedures incorporate best practices for utilization and claims reviews. Former Manager of clinical support (2015–2023) and Regional Case Manager (2011–2012) at the same company.

Experience: Executive Director, Utilization Management · MemorialCare

Executive Director, Utilization Management at MemorialCare since September 2022. Former Director Utilization Management, Case Management and Quality at MemorialCare Long Beach Medical Center (2016), Director, Quality Management at Brand New Day Health Plan (2016–2022) and Program Director, SPMI Medical Management Program at Brand New Day Health Plan (2017–2021).

Experience: Utilization Review Director · UHS

Utilization Review Director at UHS since November 2013, where the profile describes managing a team of seven Utilization Review coordinators and overseeing all Utilization Management functions for an acute inpatient behavioral health facility. Former Utilization Review Manager (2012–2013) and Utilization Review Clinician and Appeals Coordinator (2006–2012) at UHS.

Experience: Senior Director, UM Concurrent Review · Centene Corporation

Senior Director, UM Concurrent Review at Centene Corporation since July 2016, alongside a Senior Director role at Centene Corporation since November 2022. The profile cites 16 years in utilization management, care management and training and auditing roles for managed care Medicaid, Medicare and Marketplace insurance, and says the person directed utilization management and care management.

Experience: Senior Director, Utilization Management Buckeye Health Plan · Centene Corporation

Senior Director, Utilization Management Buckeye Health Plan at Centene Corporation in 2014–2017 and 2020–2025, a role the profile describes as leading utilization review operations for Medicare, Medicaid, Marketplace and MMP/Integrated Duals products in the Ohio market. Senior Director, Utilization Management at Centene Corporation since April 2025, and former Director, Utilization Management and Delegation Oversight at MediGold (2017–2020).

Experience: System Director of Utilization Review · UC Health

System Director of Utilization Review at UC Health since September 2018. The profile lists management of the Utilization Review departments at UC Medical Center and West Chester Hospital from July 2023, along with department reorganization and policy reform. Other listed roles include Denial Prevention Coordinator at Bottom Line Systems (2014–2018) and Nurse Coordinator at UnitedHealth Group (2011–2014).

Experience: Director Utilization Management · United Healthcare

Director Utilization Management at United Healthcare since March 2015 and former Associate Director Utilization Management there (2013–2015). Other listed roles include RN Manager, Utilization Management (2011–2013) and RN Manager, Inpatient Case Management (2007–2011) at UnitedHealth Group.

Experience: Director, Utilization Management · CareSource

Director, Utilization Management at CareSource since July 2022. Former Manager, Inpatient Care Utilization Management at Community Health Network of CT (2009–2022) and Onsite Facility Case Manager at ConnectiCare (2000–2009). The profile cites 20+ years as a utilization management and care coordination leader.