Strategic Leader, Clinical Utilization Management

Healthfirst; New York (NY); Hybrid; USD 119,900 - 183,430; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Life insurance

401k contributions

Job summary

Healthfirst is seeking a Senior Manager, Clinical Utilization Management (UM) Operations to lead all UM activities ensuring effective service delivery. You will oversee a team of managers and ensure compliance with state and federal regulations while driving operational excellence.

The ideal candidate will have a Bachelor's degree in Nursing or Healthcare Administration, NYS RN certification, and proven leadership experience in managing clinical teams, aiming for high performance and quality outcomes.

Qualifications

• Bachelor’s degree from an accredited institution or equivalent experience.
• NYS RN certification required.
• Understanding of UM regulatory requirements and clinical review process.

Responsibilities

• Provide oversight for all utilization management functions.
• Lead, coach, and develop UM managers overseeing clinical teams.
• Ensure compliance with regulatory requirements set by CMS and DOH.

Skills

Leadership in managing clinical teams

Analytical skills

Communication skills

Problem-solving skills

Education

Bachelor’s degree in Nursing or Healthcare Administration

NYS RN

Tools

Milliman Care Guidelines (MCG)

Data analytics and reporting tools

Job description

Healthfirst is seeking a Senior Manager, Clinical Utilization Management (UM) Operations to lead all UM activities ensuring effective service delivery. You will oversee a team of managers and ensure compliance with state and federal regulations while driving operational excellence.

The ideal candidate will have a Bachelor's degree in Nursing or Healthcare Administration, NYS RN certification, and proven leadership experience in managing clinical teams, aiming for high performance and quality outcomes.