Director of Utilization Management & Care Coordination

Healthfirst; Connecticut; Hybride; USD 103 000 - 149 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision coverage

401k contributions

Incentive and recognition programs

Résumé du poste

Healthfirst in CT/NY area is seeking a Manager of Utilization Management to oversee Case Management teams including RNs, social workers, and coordinators. The role focuses on high-quality, cost-effective allocation of services and resources.

Responsibilities include supervising staff, collaborating with medical staff, analyzing operational data, and ensuring regulatory compliance across CMS/DOH guidelines. Strong communication and leadership are essential.

Qualifications

• Minimum qualifications include an Associate’s degree.
• Preferred qualifications include RN or LPN clinical license and Master’s degree.
• Certified Case Manager credential is preferred.
• Experience in managed care, case management, discharge planning, and analytics is desired.
• Proficiency with Interqual, Milliman, TruCare and related regulatory knowledge is expected.

Responsabilités

• Oversees utilization management functions including pre-certification, concurrent review, referrals, and plan services.
• Provides coaching, conducts performance reviews, and fosters open communication and teamwork.
• Collaborates with medical staff and reviews charts to resolve complex clinical issues.
• Develops and analyzes operational reports to monitor efficiency.
• Documents utilization management activities and rationale in EMR systems.
• Acts as a clinical resource for the care team to optimize patient care and cost management.
• Additional duties as assigned.

Connaissances

Communication

Time management

Critical thinking

Problem solving

Supervisory experience

Leadership

Formation

Associate’s degree

Master’s degree

Certified Case Manager

Outils

Interqual

Milliman

TruCare

CMS/NYSDOH knowledge

PHI systems

MS Office/Project suite

Description du poste

Healthfirst in CT/NY area is seeking a Manager of Utilization Management to oversee Case Management teams including RNs, social workers, and coordinators. The role focuses on high-quality, cost-effective allocation of services and resources.

Responsibilities include supervising staff, collaborating with medical staff, analyzing operational data, and ensuring regulatory compliance across CMS/DOH guidelines. Strong communication and leadership are essential.