Senior Manager, Clinical UM Operations & Transformation

Healthfirst; Connecticut; On-site; USD 105,000 - 160,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k contributions

Incentive and recognition programs

Job summary

Healthfirst seeks a Senior Manager, Clinical Utilization Management Operations to lead strategic and operational UM activities, focusing on modernization, standardization, and scalable workflows. You will oversee clinicians and coordinators performing medical necessity review, service authorization, and care coordination in a regulated environment.

You will partner with VP-level leadership and external partners to drive transformation, manage performance, and ensure alignment with CMS/DOH

Qualifications

• Strong leadership and people-management capabilities in a regulated healthcare setting.
• Deep understanding of utilization management regulatory requirements and clinical review processes.
• Proven ability to translate clinical/operational needs into scalable workflows and systems.
• Experience guiding large, multidisciplinary teams through change and transformation.

Responsibilities

• Lead design and implementation of future-state UM workflows and operating practices.
• Collaborate with leadership, consultants, PM, technology and vendors to execute UM transformation priorities.
• Ensure readiness and adoption of new technologies, workflows, and capabilities.
• Apply AI, automation and analytics to improve UM operations while maintaining compliance.

Skills

Leadership

Regulatory knowledge

Analytical ability

Cross-functional collaboration

Education

Bachelor's degree in Nursing/Healthcare Administration

NYS RN license

Job description

Healthfirst seeks a Senior Manager, Clinical Utilization Management Operations to lead strategic and operational UM activities, focusing on modernization, standardization, and scalable workflows. You will oversee clinicians and coordinators performing medical necessity review, service authorization, and care coordination in a regulated environment.

You will partner with VP-level leadership and external partners to drive transformation, manage performance, and ensure alignment with CMS/DOH