New York Licensed Director of Utilization Management

Job Summary

Leading a dedicated team, 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 working in a hybrid environment.

Key responsibilities

• Oversee inpatient, outpatient, and long-term support service reviews to ensure quality care and compliance
• Develop and direct annual departmental programs, monitoring key performance indicators for effective utilization management
• Maintain staffing levels and ensure comprehensive training 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 in 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