Senior Manager, UM Operations & Transformation
Healthfirst
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Benefits offered by this job
Job summary
Healthfirst seeks a Senior Manager, Clinical Utilization Management Operations in New York to lead modernization efforts across UM activities. You will partner with senior leaders, drive transformation, and oversee clinicians and coordinators performing medical necessity reviews and care coordination.
The role emphasizes compliance, efficiency, and stakeholder adoption. Responsibilities include directing future-state workflows, enabling technology-enabled transformation, and managing regulatory
Qualifications
- Bachelor’s degree in Nursing, Healthcare Administration, or related field from an accredited institution or equivalent work experience NYS RN
- Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations.
- Leadership experience in managing, coaching and developing multidisciplinary clinical teams.
- Strong analytical, organizational, and problem-solving skills.
Responsibilities
- Partner with UM Directors and VP to advance future-state UM workflows and operating practices.
- Collaborate with UM leadership, technology, and vendors to support UM transformation priorities.
- Provide strategic oversight for utilization management functions including prior authorization and concurrent review.
- Lead readiness for audits, performance improvement plans, and corrective actions.
Skills
Education
Job description
Healthfirst seeks a Senior Manager, Clinical Utilization Management Operations in New York to lead modernization efforts across UM activities. You will partner with senior leaders, drive transformation, and oversee clinicians and coordinators performing medical necessity reviews and care coordination.
The role emphasizes compliance, efficiency, and stakeholder adoption. Responsibilities include directing future-state workflows, enabling technology-enabled transformation, and managing regulatory
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