New York Licensed Director of Utilization Management

Job Summary

Leading a dedicated team in a hybrid work environment, the full-time New York Licensed Director of Utilization Management will oversee daily operations of the UM Department, manage transitions of care, and ensure compliance with regulatory standards while driving innovative solutions for quality enhancement and cost containment.

Key responsibilities

• Oversee inpatient, outpatient, and long-term support service reviews, ensuring alignment with the VillageCareMAX benefit profile
• Develop and direct annual departmental programs while monitoring key performance indicators for effective utilization management
• Maintain staffing levels and provide comprehensive training and ongoing education for clinical and non-clinical UM personnel

Required qualifications

• Minimum of 5 years management experience in a health-related field
• At least 3 years of experience in a quality management role
• Proficiency in analyzing data to drive improvement activities
• Knowledge of regulatory structures governing quality management within Medicare and Medicaid health plans
• Bachelor's Degree required; Master's Degree preferred; active NYS (RN) License or willingness to obtain within 3 months of hire