Senior Manager, Clinical UM Transformation

Healthfirst

Florida

On-site

USD 105,000 - 160,000

Full time

8 hours ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

401k contributions

Job summary

Healthfirst seeks a Senior Manager, Clinical Utilization Management Operations to provide strategic and operational leadership for UM activities, advancing transformation and modernization. You will oversee clinicians and coordinators handling medical necessity review, prior authorization, and care coordination while ensuring compliant, high-quality member-centered operations.

You will partner with directors, VP, consultants, and project teams to design future-state workflows, translate needs

Qualifications

Bachelor's degree in Nursing, Healthcare Administration, or related field or equivalent work experience.
NYS RN license required.
Demonstrated understanding of UM regulatory requirements and managed care operations.
Leadership experience in managing multidisciplinary clinical teams.

Responsibilities

Lead design and implementation of future-state UM workflows, processes, and operating practices to support modernization and scalability.
Collaborate with UM leadership, project management, tech, and vendor teams to execute UM transformation priorities.
Provide UM operational expertise to identify requirements, risks, dependencies, and impacts to frontline teams.
Support adoption of new technologies and workflows through stakeholder engagement, training, and stabilization.
Apply AI and automation to identify opportunities that improve UM operations while aligning with compliance and clinical workflows.