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7 Director Clinical Operations - Utilization Management Resume Templates with Example

By Ria · Last Updated On October 25, 2026
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This guide shows you how to create a Director Clinical Operations - Utilization Management resume that presents leadership, clinical judgment, and operational results clearly. You will learn how to organize relevant experience and choose a layout that helps readers review your qualifications.

A strong resume for this role connects Utilization Management strategy with quality, affordability, compliance, and member outcomes. Use clear section headings and focused bullet points to show how you guide teams, track performance, and work with clinical and Product partners.

The example is presented in 7 layouts. Compare the image previews to see how each format arranges experience, skills, education, and credentials, then open an example in the editor to review or customize its structure.

What Makes a Great Director Clinical Operations - Utilization Management Resume in 2026

A strong resume for this role makes leadership scope, UM operations, and results easy to find. Use concise bullets to show how you improve quality, affordability, compliance, and member outcomes.

Add role-specific terms where they match your experience, such as dashboards, key performance indicators, delegated operations, Medicaid and Medicare compliance, and peer-to-peer review. Include clear evidence, such as audit improvements or stronger service measures, when available.

Note: Resume examples are for educational purposes only. Use only information that accurately reflects your experience and qualifications. References to real organizations do not imply affiliation or endorsement.

#1 Plain Two Column Format Resume Example

The Plain Two Column Format uses two columns to keep career history and supporting qualifications easy to scan together.

 
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Resume Snapshot

  • 20 years of progressive health services experience
  • More than a decade leading complex UM and Medical Management operations
  • Master of Science in Nursing, Health Systems Leadership
  • Current, unrestricted Minnesota RN license and Certified Case Manager (CCM)

Why This Format Works

  • Two-column structure can separate career history from supporting qualifications.
  • A focused reading path helps reviewers trace roles from nursing review to operations leadership.
  • Education and credentials can sit beside work history in a compact review.

Best For

  • Side-by-side resume review
  • Leadership histories with multiple roles
  • Career details plus supporting qualifications
  • Concise education and credential sections
  • Readers comparing experience and skills

Resume Keywords

  • 20 years of progressive health services experience
  • Bachelor of Science in Nursing
  • Registered Nurse, Minnesota, unrestricted and current
  • more than a decade leading complex Utilization Management and Medical Management operations
  • Clinical operations strategy
  • Established a performance review cadence using dashboards, key performance indicators, quality measures, service-level metrics, and industry benchmarks, giving leaders a shared basis for resource and improvement decisions.
  • Introduced a monthly UM improvement cycle that paired case-audit findings with service-level and productivity trends, assigning corrective actions to accountable managers and reducing recurring documentation gaps across clinical teams.
  • Built a leader development series around calibration sessions, escalation scenarios, and coaching reviews, helping managers apply consistent decisions and guide staff through workflow and policy changes.
  • Lead managers through workflow redesign and organizational change
  • performance guarantees
  • Affordability of Care (AOC) targets
  • dashboards, key performance indicators
  • standardize productivity, quality, and service-level metrics, then used regular reviews to address variation and strengthen accountability.
  • Workforce management
  • regulatory and accreditation compliance
See all keywords
 

#2 Simple One Column Format Resume Example

The Simple One Column Format keeps the resume in a single reading path, which suits readers who prefer a straightforward review.

 
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Why This Format Works

  • Full-width experience bullets give complex leadership details room to read clearly.
  • Section-by-section flow helps reviewers locate education, credentials, and skills in order.
  • Career progression stays easy to follow from clinical review to senior operations.

Best For

  • Sequential career histories
  • Detailed experience bullets
  • Single-path document review
  • Traditional section-by-section reading
  • Resumes with several supporting sections
 

#3 Clean Two Column Sidebar Format Resume Example

The Clean Two Column Sidebar Format uses two columns, offering a clear way to review career history and supporting information.

 
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Why This Format Works

  • Two reading areas can distinguish career progression from supporting qualifications.
  • The main experience sequence gives leadership roles a clear chronological path.
  • Skills, education, and credentials remain part of one organized resume view.

Best For

  • Side-by-side section review
  • Career history with supporting details
  • Resumes balancing experience and education
  • Readers who prefer a sidebar
  • Compact skills and credential lists
 

#4 Two Column Format Resume Example

The Two Column Format divides resume content into two areas, helping reviewers compare career experience with supporting qualifications.

 
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Why This Format Works

  • Two columns give experience and education separate areas for quick review.
  • Chronological roles help reviewers follow growth across clinical and leadership work.
  • Skills and credentials can be checked without losing the experience sequence.

Best For

  • Two-area resume scanning
  • Experience paired with supporting sections
  • Multi-role career histories
  • Readers comparing key resume sections
  • Resumes with varied qualifications
 
 

#5 Photo Header Two Column Format Resume Example

The Photo Header Two Column Format pairs a photo header with a two-column resume body, combining a profile image with organized content.

 
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Why This Format Works

  • The two-column body separates experience from supporting qualifications for review.
  • Career progression remains easy to trace across the work history.
  • Education and credentials can be found without crowding the experience sequence.

Best For

  • Photo-forward resume headers
  • Parallel section reading
  • Experience with supporting qualifications
  • Career timelines spanning several roles
  • Resumes with distinct education and credentials
 

#6 Colored Two Column Format Resume Example

The Colored Two Column Format arranges resume content in two columns, making it easier to scan experience and related qualifications as separate areas.

 
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Why This Format Works

  • Two columns give the career history and supporting sections distinct reading areas.
  • A chronological experience list helps reviewers trace increasing leadership scope.
  • Skills and education are easier to check alongside the work history.

Best For

  • Two-column resume scanning
  • Dense career history with added sections
  • Experience alongside supporting details
  • Readers comparing resume sections
  • Resumes with varied credentials
 

#7 Stylish Two Column Designer Format Resume Example

The Stylish Two Column Designer Format presents content in two columns, a useful option for readers who like side-by-side organization.

 
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Why This Format Works

  • Side-by-side content areas help reviewers move between experience and qualifications.
  • The work history remains visible as reviewers check skills and education.
  • Chronological entries support a clear view of clinical and leadership progression.

Best For

  • Side-by-side content organization
  • Resumes with detailed career histories
  • Experience plus supporting qualifications
  • A preference for two-column resumes
  • Career documents with multiple section types
 
 

Why Build Your Director Clinical Operations - Utilization Management Resume with ResumeInMinutes

ResumeInMinutes helps you arrange your experience, skills, education, and credentials in a clear resume. Compare image previews to see how the layouts present your information, then open an example in the editor to review or customize it.

  • Multiple resume layouts
  • Clear, ATS-readable sections
  • Role-focused keyword guidance
  • Organized experience and skills
  • Image previews for comparison
  • Resume customization in the editor

Use the example as a guide to show your UM leadership, clinical operations work, team development, and measurable improvements. Keep each detail accurate and relevant to the Director Clinical Operations - Utilization Management role.

 

See Also

 

Frequently Asked Questions

Are these Director Clinical Operations - Utilization Management resume layouts ATS-friendly?

The layouts use clear sections and readable headings to support resume scanning. Include relevant terms, such as Utilization Management, operational performance, dashboards, regulatory compliance, and vendor oversight, when they match your background.

Does this guide show one resume example in different layouts?

Yes. It presents one Director Clinical Operations - Utilization Management resume example in different visual formats. Compare the image previews and open an example in the editor to review its structure.

What should a Director Clinical Operations - Utilization Management resume include?

Include a focused summary, relevant experience, education, licenses or certifications, and role-related skills. Use concise bullets to show team leadership, UM operations, compliance work, performance measures, and results.

Which resume layout works well for this role?

Choose a layout with clear headings and an easy-to-follow experience section. A simple structure can help readers find leadership scope, key results, education, and credentials quickly.

How can I show results in a clinical operations resume?

Describe the action you took, the operational area affected, and the result. Where you have reliable figures, include measures such as audit findings, service levels, productivity, quality, or case review performance.

Should I include a photo on my resume?

Include a photo only if it is customary or expected in your region, industry, or role. For U.S. applications, a resume without a photo is usually a safer choice.

ATS score and resume checks

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ATS Score 93%

How we calculate this score

  • Keywords: 60% of the total. AI extracts keywords from your job description. If you do not provide one, a standard job description for the title matching your resume is used. This is not a match to a specific vacancy.
  • Text-based resume: 20%. The text resume assessed here receives 100 for this part.
  • Resume quality: 20%. We start at 100 and subtract points for issues found by our resume checks, down to a minimum of zero.
  • Keyword coverage = round(100 × confirmed matches ÷ total keywords). Exact matches and supported equivalents verified by AI receive full credit; unsupported keywords receive none. Live text checks use the saved equivalents and do not request a new AI review. Without keywords, no overall ATS score is available.
  • Final score = 60% of keyword coverage + 20% of the text score + 20% of the quality score, rounded to a whole number. Without keywords, no overall ATS score is available.

What this score means

Our scores are estimates, not employer ratings. They may contain errors and do not guarantee accurate parsing, a ranking, an interview, or a job. Check your document against the employer’s requirements. You are responsible for relying on this score.

Terms and Conditions

Score weights: Keywords 60% · Text based resume 20% · Resume quality 20%

Keyword coverage: 38 of 43 (88%) · Resume quality: 100%

Resume quality 100% · Weight 20% · Issues (0)

Details
  • ✓Name present: Paisley Herrera
  • ✓Email format: paisley.herrera@example.com
  • ✓Phone format: (612) 555-XXXX
  • ✓Experience 1: Job title: Director, Utilization Management Operations
  • ✓Experience 1: Company name: Summit Harbor Health
  • ✓Experience 1: Work location: Minneapolis, MN
  • ✓Experience 1: Employment dates: June 2021 - Present
  • ✓Experience 1: Description or achievements: Present
  • ✓Experience 2: Job title: Senior Manager, Clinical Operations
  • ✓Experience 2: Company name: Cedar Ridge Health Services
  • ✓Experience 2: Work location: St. Paul, MN
  • ✓Experience 2: Employment dates: March 2017 - May 2021
  • ✓Experience 2: Description or achievements: Present
  • ✓Experience 3: Job title: Clinical Operations Manager
  • ✓Experience 3: Company name: Meridian Benefit Partners
  • ✓Experience 3: Work location: Bloomington, MN
  • ✓Experience 3: Employment dates: January 2013 - February 2017
  • ✓Experience 3: Description or achievements: Present
  • ✓Experience 4: Job title: Clinical Program Supervisor, RN
  • ✓Experience 4: Company name: HarborPoint Medical Group
  • ✓Experience 4: Work location: Eden Prairie, MN
  • ✓Experience 4: Employment dates: August 2009 - December 2012
  • ✓Experience 4: Description or achievements: Present
  • ✓Experience 5: Job title: Registered Nurse, Utilization Review
  • ✓Experience 5: Company name: Lakeshore Community Health
  • ✓Experience 5: Work location: Duluth, MN
  • ✓Experience 5: Employment dates: June 2006 - July 2009
  • ✓Experience 5: Description or achievements: Present
  • ✓No placeholder fields
  • ✓No repeated achievement bullets
  • ✓No empty bullets

No issues found by the current checks.

Text Based Resume 100% · Weight 20%

Parsed text
Paisley Herrera
Director, Clinical Operations
(612) 555-XXXX
paisleyherrera
paisley.herrera@example.com
Minneapolis, MN 55416
STRENGTHS
Leader development
Coached nurse supervisors on staff growth and clinical review quality, sharing practical guidance they could use with their teams.
Change leadership
Guided managers through a multi-team service transition, helping clarify priorities and keep operational readiness in view.
Operational judgment
Used quality findings and service measures to identify process gaps and direct supervisor coaching on corrective action.
Clinical partnership
Worked with medical directors on complex cases and peer-to-peer discussions, presenting clinical concerns in concise summaries.
Member-centered review
Considered care access and social determinants of health when reviewing referrals and identifying follow-up needs for members.
SUMMARY
Clinical operations executive with 20 years of progressive health services experience, including more than a decade leading complex Utilization Management and Medical Management operations. Connect clinical judgment, product strategy, regulatory requirements, and operating performance across case management, behavioral health, and physical health. Develop people leaders and guide teams through change, using dashboards and performance measures to set priorities. Partner with medical directors, Product, vendors, and regulatory stakeholders to support quality, affordability, compliance, and positive member outcomes.
EXPERIENCE
Director, Utilization Management Operations
Summit Harbor Health
June 2021 - Present
Minneapolis, MN
Direct multi-discipline UM operations across physical health, behavioral health, and case management, translating organizational goals into clinical quality, affordability, compliance, and member-outcome priorities.
Partner with the UM Product Manager to set and track Affordability of Care (AOC) targets, using claims trends and clinical review findings to shape product initiatives and operational responses.
Established a performance review cadence using dashboards, key performance indicators, quality measures, service-level metrics, and industry benchmarks, giving leaders a shared basis for resource and improvement decisions.
Lead managers through workflow redesign and organizational change, coaching on priority setting, staff development, performance management, employee relations, policy administration, and cost control.
Oversee delegated clinical operations and vendor performance across onshore, offshore, and blended models; clarify accountability for UM standards, audit findings, quality expectations, and performance guarantees.
Coordinate operational readiness and regulatory and accreditation compliance through policy and procedure updates, program descriptions, audits, training, and routine monitoring of Medicaid, Medicare, and Public Programs requirements.
Work with medical directors and clinical leaders on peer-to-peer review, pharmaceutical medical review, and related clinical review processes, ensuring clinical staff can practice at the top of their licensure.
Develop and prioritize business cases for operational improvements, assess tools and technology for quality and efficiency, and lead adoption when the expected business value is supported.
Present program performance and value through dashboards, RFP content, client meetings, formal presentations, and committee participation; maintain relationships with external customers, regulatory bodies, and Blue Plan resources.
Introduced a monthly UM improvement cycle that paired case-audit findings with service-level and productivity trends, assigning corrective actions to accountable managers and reducing recurring documentation gaps across clinical teams.
Built a leader development series around calibration sessions, escalation scenarios, and coaching reviews, helping managers apply consistent decisions and guide staff through workflow and policy changes.
Senior Manager, Clinical Operations
Cedar Ridge Health Services
March 2017 - May 2021
St. Paul, MN
Managed UM and Medical Management teams serving commercial and government-sponsored health insurance members, integrating clinical priorities with Product initiatives and service commitments.
Guided managers through a restructure and expanded service volumes by defining team responsibilities, coaching leaders, and creating clear escalation paths for complex operational challenges.
Partnered with workforce management to standardize productivity, quality, and service-level metrics, then used regular reviews to address variation and strengthen accountability.
Improved vendor oversight by aligning delegated partner reporting, audit schedules, and corrective action follow-up with internal quality expectations.
Coordinated with medical directors on clinical review workflows and peer-to-peer activity, improving consistency in case escalation and decision documentation.
Prepared operating plans and business cases, and shared performance findings with internal committees and client stakeholders using concise reports and dashboards.
Evaluated delegated, onshore, offshore, and blended service arrangements against audit results, turnaround measures, and staffing needs, recommending adjustments that maintained clinical review standards during volume growth.
Facilitated cross-functional issue reviews with Product, clinical leaders, and vendor contacts, tracing delayed case decisions to handoff gaps and clarifying escalation ownership to protect service commitments.
Clinical Operations Manager
Meridian Benefit Partners
January 2013 - February 2017
Bloomington, MN
Led daily operations for utilization review and case management teams supporting physical health and behavioral health services for health plan members.
Used quality audits, service-level reporting, and case trends to identify process gaps and coach supervisors on corrective action and consistent clinical documentation.
Worked with Product, analytics, and technology partners to assess workflow changes, test implementation readiness, and communicate operational impacts to clinical staff.
Maintained program descriptions, policies and procedures, training materials, and audit records for regulatory and accreditation readiness.
Coordinated medical director review and pharmaceutical medical review referrals, incorporating medical terminology and clinical documentation requirements into staff guidance.
Mapped authorization intake and clinical review handoffs with technology partners, then tested a revised work queue and staff guidance to reduce avoidable routing errors and improve case visibility.
Clinical Program Supervisor, RN
HarborPoint Medical Group
August 2009 - December 2012
Eden Prairie, MN
Supervised nurses supporting utilization review and case management, balancing timely clinical decisions with member needs, health plan requirements, and documentation standards.
Built case review and training routines for behavioral health and physical health referrals, helping nurses apply consistent criteria and recognize social determinants of health affecting care access.
Collaborated with medical directors on complex cases and peer-to-peer discussions, escalating clinical concerns with concise, evidence-based summaries.
Monitored queue volumes and quality findings, adjusting assignments and coaching staff to maintain dependable service during periods of demand fluctuation.
Registered Nurse, Utilization Review
Lakeshore Community Health
June 2006 - July 2009
Duluth, MN
Reviewed inpatient and outpatient requests for medical necessity, applying clinical documentation, medical terminology, and health insurance guidelines to support timely UM decisions.
Coordinated case information with treating providers and internal clinicians, documenting rationale and routing complex cases to medical directors for review.
Supported member transitions from acute care through early case management outreach, identifying follow-up needs and barriers related to social determinants of health.
SKILLS
Case management
Physical health
Clinical operations strategy
Operational performance
Utilization management
Workforce management
Accreditation readiness
Regulatory compliance
Medical management
Leader development
Affordability of Care
Product partnership
Vendor oversight
Behavioral health
Clinical review
MY CAREER
20.4Years
Director, Utilization Management Operations at Summit Harbor Health (5.4 Years)
Senior Manager, Clinical Operations at Cedar Ridge Health Services (4.2 Years)
Clinical Operations Manager at Meridian Benefit Partners (4.2 Years)
Clinical Program Supervisor, RN at HarborPoint Medical Group (3.4 Years)
Registered Nurse, Utilization Review at Lakeshore Community Health (3.2 Years)
LEADERSHIP, AWARDS & RECOGNITION
Recognized by clinical leadership in 2024 for strengthening manager coaching and operational readiness during a multi-team service transition.
Served as a peer mentor for nurse supervisors from 2019 to 2021, sharing approaches to clinical review quality, staff development, and change communication.
Received a health plan quality commendation in 2016 for improving audit follow-up and clinical documentation consistency.
EDUCATION
Master of Science in Nursing
University of Minnesota
2011
Minneapolis, MN
Bachelor of Science in Nursing
University of Wisconsin–Eau Claire
2003
Eau Claire, WI
CERTIFICATIONS
Registered Nurse, Minnesota, unrestricted and current
Certified Case Manager (CCM)
2012
PROFESSIONAL SKILLS
Clinical Documentation: Epic, Cerner, MEDITECH
Care Management Platforms: CarePort, GuidingCare, MCG Cite AutoAuth
Clinical Review Resources: InterQual, MCG Care Guidelines, Milliman Care Guidelines
Health Plan Administration: HealthRules, Facets, QNXT
Analytics and Reporting: Microsoft Excel, Microsoft Power BI, Tableau
Workforce and Collaboration: Microsoft Teams, Microsoft SharePoint, Microsoft PowerPoint
PROFESSIONAL AFFILIATIONS
Member, American Association of Managed Care Nurses, connecting with peers on clinical operations and utilization review practices.
Member, American Case Management Association, engaging with case management professionals on care coordination and member support.

Matched keywords (38)

  • 20 years of progressive health services experienceOriginal keyword in JD: 7+ years of progressive health services experience
  • Bachelor of Science in NursingOriginal keyword in JD: Bachelor’s degree OR two additional years of relevant experience
  • Registered Nurse, Minnesota, unrestricted and currentOriginal keyword in JD: Current, unrestricted Minnesota licensure: RN OR licensed independent mental health practitioner (preferred)
  • more than a decade leading complex Utilization Management and Medical Management operationsOriginal keyword in JD: Complex UM operations leadership
  • Clinical operations strategy
  • Established a performance review cadence using dashboards, key performance indicators, quality measures, service-level metrics, and industry benchmarks, giving leaders a shared basis for resource and improvement decisions.Original keyword in JD: Operational performance management
  • Introduced a monthly UM improvement cycle that paired case-audit findings with service-level and productivity trends, assigning corrective actions to accountable managers and reducing recurring documentation gaps across clinical teams.Original keyword in JD: Continuous improvement
  • Built a leader development series around calibration sessions, escalation scenarios, and coaching reviews, helping managers apply consistent decisions and guide staff through workflow and policy changes.Original keyword in JD: People leader development
  • Lead managers through workflow redesign and organizational changeOriginal keyword in JD: Organizational change leadership
  • performance guarantees
  • Affordability of Care (AOC) targets
  • dashboards, key performance indicatorsOriginal keyword in JD: Dashboards and key performance indicators
  • standardize productivity, quality, and service-level metrics, then used regular reviews to address variation and strengthen accountability.Original keyword in JD: Productivity, quality, and service-level management
  • Workforce management
  • regulatory and accreditation compliance
  • Medicaid, Medicare, and Public Programs
  • operational readiness
  • policy and procedure updates, program descriptionsOriginal keyword in JD: Policies, procedures, and program descriptions
  • case-audit findings with service-level and productivity trends, assigning corrective actions to accountable managersOriginal keyword in JD: Audits and corrective action
  • delegated clinical operations
  • Improved vendor oversight by aligning delegated partner reporting, audit schedules, and corrective action follow-up with internal quality expectations.Original keyword in JD: Vendor relationship management
  • onshore, offshore, and blended modelsOriginal keyword in JD: Onshore, offshore, and blended operating models
  • Partner with the UM Product ManagerOriginal keyword in JD: Product team partnership
  • Work with medical directors and clinical leaders on peer-to-peer review, pharmaceutical medical review, and related clinical review processesOriginal keyword in JD: Medical director and clinical leader collaboration
  • peer-to-peer review
  • pharmaceutical medical review
  • Case management
  • Behavioral health
  • Physical health
  • Managed Care
  • health insurance
  • medical terminology
  • social determinants of health
  • Develop and prioritize business cases for operational improvementsOriginal keyword in JD: Business case development and prioritization
  • assess tools and technology for quality and efficiency, and lead adoption when the expected business value is supported.Original keyword in JD: Clinical tools and technology implementation
  • maintain relationships with external customers, regulatory bodies, and Blue Plan resources.Original keyword in JD: Stakeholder relationship management
  • cost control
  • Master of Science in NursingOriginal keyword in JD: Master’s degree in a related field (preferred)

Missing keywords (5)

  • Utilization Management (UM) strategy and operations
  • 3+ years of management experience
  • Strategic problem-solving
  • Communication and facilitation
  • RFP materials and client presentations
Disclaimer: All names, images, contact information, employment histories, achievements, security clearances, military credentials, and other qualifications shown in this content are fictional and used for illustrative purposes only. Any resemblance to actual persons, living or deceased, is purely coincidental.

Resume and cover-letter examples and recommendations in this article reflect general best practices and professional experience and are provided for guidance only. Results may vary based on role, industry, region, and hiring organization.

Content Accuracy and Verification: To the fullest extent permitted by applicable law, we do not represent or warrant that resume or cover-letter guidance, examples, recommendations, or related information are accurate, complete, current, error-free, or suitable for any particular purpose. You are responsible for independently reviewing and verifying the information before relying on it.

ATS and Cover-Letter Scores: ATS scores are estimates calculated using our own formula, informed by publicly available guidance on resume formatting and keyword matching. They are not scores issued or endorsed by an ATS provider or employer. Cover-letter scores are also our own assessments. Parsing, weighting, screening criteria, and results vary between systems, employers, job descriptions, and document formats. No score guarantees successful parsing, a particular ranking, an interview, or employment. Use scores as general guidance and independently check your documents against the employer’s requirements. To the fullest extent permitted by applicable law, we accept no liability for errors in scores or parsing, or losses arising from reliance on these assessments. Nothing in this notice excludes liability or limits consumer rights that cannot lawfully be excluded or limited.

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