New York State Licensed Director of Utilization Management

Job Summary

Leading a dedicated team, the full-time New York State 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 enhance utilization management processes
• Develop and direct annual departmental programs while monitoring key performance indicators for effective care delivery
• Ensure adequate staffing and 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 data analysis 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, along with an active NYS (RN) License or willingness to obtain within 3 months of hire