Utilization Management Lead - Case & Cost Oversight

HealthFirst

Connecticut

On-site

USD 103,000 - 149,000

Full time

5 days ago

Be an early applicant

A complete application in a minute

Tailored resume and cover letter, ready to send.

Get past ATS filters

Job summary

HealthFirst seeks an experienced Manager of Utilization Management to oversee Case Management teams, ensuring high-quality, cost-effective care. You will supervise staff, collaborate with medical personnel, and analyze data to improve utilization and patient outcomes.

The role requires regulatory knowledge (CMS/NYSDOH/MLTCP), strong leadership, and experience in managed care. A licensed RN/LPN and an advanced degree are preferred, with strong communication and project-management skills.

Qualifications

Associate’s degree required.
RN or LPN license preferred.
Master’s degree preferred.
Excellent communication and problem-solving skills.
Supervisory or management experience desirable.
Experience in managed care and case management.
Certified Case Manager and knowledge of Interqual/Milliman/TruCare preferred.
Knowledge of CMS/NYSDOH/MLTCP regulations governing medical management.

Responsibilities

Oversee utilization management including pre-certification, concurrent review, and referrals.
Develop and monitor staff goals; conduct annual performance reviews.
Collaborate with medical staff and review charts to obtain information.
Develop and analyze reports to monitor operational efficiency.
Document utilization management activities in EMR systems.
Act as a clinical resource to maximize patient care and cost management.
Perform additional duties as assigned.