Strategic Manager, Utilization & Clinical Care

Healthfirst; New York (NY); Hybrid; USD 117,000 - 169,000; Full time

Job summary

Healthfirst is seeking a Manager of Utilization Management in New York to oversee Case Management teams including RNs, social workers, and coordinators, ensuring quality, cost-effective, and appropriate member care. The role collaborates with medical staff, analyzes utilization data, and maintains documentation in EMR systems while supporting the care management team and external providers.

Candidates should have a clinical license and leadership experience in managed care with strong

Qualifications

• Associate degree or clinical license required; RN/LPN/LMSW/LCSW or equivalent.
• BSN and 5+ years of progressive clinical leadership in managed care preferred.
• CCM/ACM or comparable certification preferred; strong communication and leadership are essential.

Responsibilities

• Oversees utilization management functions including authorizations, pre-certification, and reviews.
• Leads staff development, coaching, and performance reviews to drive quality and teamwork.
• Collaborates with medical staff to obtain information and resolve complex clinical issues.
• Develops and analyzes reports to monitor operational efficiency and utilization trends.
• Documents utilization actions and rationale in EMR systems.
• Acts as a clinical resource to maximize patient care while managing medical costs.

Skills

Communication skills

Problem solving

Multitasking

Education

Associate degree or clinical license

BSN

CCM/ACM certification

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Outlook

Job description

Healthfirst is seeking a Manager of Utilization Management in New York to oversee Case Management teams including RNs, social workers, and coordinators, ensuring quality, cost-effective, and appropriate member care. The role collaborates with medical staff, analyzes utilization data, and maintains documentation in EMR systems while supporting the care management team and external providers.

Candidates should have a clinical license and leadership experience in managed care with strong