Chief of Utilization Management & Clinical Operations

EmblemHealth; New York (NY); On-site; USD 325,000 - 400,000; Full time

Job summary

EmblemHealth is seeking an accomplished senior leader to drive Utilization Management across Medicaid, Commercial, and Medicare. You will provide executive clinical and operational direction, oversee 250 UM staff and external vendors, and shape a modern data-driven UM operating model focused on access, affordability, and quality outcomes.

The role demands 10+ years of physician leadership, a clinical license, and a Bachelor’s degree (MBA preferred).

Qualifications

• Bachelor’s degree required.
• Clinical license such as MD, DO, or other unrestricted physician license required.
• 10+ years of progressive physician leadership experience.

Responsibilities

• Lead UM strategic redesign and day‑to‑day management across Medicaid, Commercial, and Medicare.
• Provide senior clinical and operational leadership for UM with vendor oversight.
• Ensure clinically appropriate, compliant UM operations and improve access and affordability.
• Oversee approximately 250 UM staff and external vendors; drive enterprise transformation.

Skills

Strategic leadership

Utilization Management

Executive leadership

Change management

Education

Bachelor’s degree

MBA or advanced degree

Job description

EmblemHealth is seeking an accomplished senior leader to drive Utilization Management across Medicaid, Commercial, and Medicare. You will provide executive clinical and operational direction, oversee 250 UM staff and external vendors, and shape a modern data-driven UM operating model focused on access, affordability, and quality outcomes.

The role demands 10+ years of physician leadership, a clinical license, and a Bachelor’s degree (MBA preferred).