VP of Utilization Management & Medical Strategy

VNS Health; New York (NY); On-site; USD 194,000 - 258,000; Full time

Job summary

VNS Health in New York is seeking a senior leader to oversee utilization management and medical management functions. You will direct prior authorization operations, ensure CMS and state regulatory compliance, and drive process transformation across UM, medical policies, and documentation standards.

You will collaborate with medical directors, care managers, provider network management, claims, and quality teams to optimize resource use, monitor KPIs, and mentor a team of nurses and case

Qualifications

• Bachelor's degree in healthcare administration or related field.
• Master's degree preferred.
• Minimum 8 years of progressive utilization management or related managed care experience.
• Demonstrated people leadership and coaching experience.
• Strong knowledge of CMS requirements and regulatory compliance.

Responsibilities

• Designs and implements utilization management programs and procedures.
• Leads evaluation and redesign of UM and prior authorization processes.
• Oversees UM review processes for medical necessity and efficiency.
• Partners with cross-functional teams including Medical Directors and Provider Network Management.
• Develops KPIs and monitors performance metrics.
• Ensures audit readiness and regulatory compliance.

Skills

Utilization management

Leadership

CMS requirements

Regulatory compliance

Analytical skills

Process improvement

Cross-functional collaboration

Prior authorization

Communication skills

Healthcare operations

Education

Bachelor's Degree in Healthcare Administration

Master's Degree preferred

Job description

VNS Health in New York is seeking a senior leader to oversee utilization management and medical management functions. You will direct prior authorization operations, ensure CMS and state regulatory compliance, and drive process transformation across UM, medical policies, and documentation standards.

You will collaborate with medical directors, care managers, provider network management, claims, and quality teams to optimize resource use, monitor KPIs, and mentor a team of nurses and case