NY Licensed Clinical Utilization Manager

Job Summary

Overseeing utilization management functions, the full-time NY Licensed Clinical Utilization Manager will ensure high-quality, cost-effective member services while collaborating with care management teams and external medical providers in a remote setting.

Key responsibilities

• Manage timely authorizations for pre-certification, concurrent reviews, and referrals
• Develop and monitor staff goals, providing feedback and conducting performance reviews
• Collaborate with medical staff to review charts and solve complex clinical problems

Required qualifications

• Associate's degree
• RN or LPN clinical license preferred
• Experience in managed care and case management for high-risk populations
• Knowledge of CMS and NYSDOH regulations governing medical management
• Familiarity with utilization management philosophies and reporting requirements