Director of Utilization Management
About The Position
Join VillageCare as the Full-Time Director of Utilization Management and take the helm of a critical role in advancing patient care and operational excellence within New York's competitive health care landscape. This position offers the unique opportunity to lead a dedicated team while enjoying the flexibility of a remote work environment, allowing for a healthy work-life balance. With a salary range of $118,135.58 - $132,902.53, you will be compensated competitively for your expertise and commitment to customer-centric service. As a forward-thinking leader, you will tackle complex challenges head-on and implement innovative solutions that enhance our utilization management processes. You will be part of a high-performance culture that values integrity and excellence in all aspects of care delivery. Embrace your chance to make a meaningful impact while working remotely in this vital position at VillageCare. VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.
Requirements
- A minimum of 5 years management experience in a health-related field
- A minimum of 3 years' experience in a quality management position
- Experience analyzing and using data to drive improvement activities
- Knowledge of regulatory structure governing quality management in Medicare and Medicaid health plans.
- Bachelor's Degree required.
- Active NYS (RN) License or willing to obtain within 3 months of hire required
Nice To Haves
- Master's degree preferred
Responsibilities
- Overseeing the daily operations of the UM Department, encompassing critical areas such as inpatient, outpatient, and long-term support service reviews.
- Managing transitions of care and discharge planning.
- Ensuring that outpatient services align with the VillageCareMAX benefit profile.
- Developing and directing annual departmental programs.
- Monitoring key performance indicators to promote effective utilization management functions.
- Delivering quality, medically appropriate care that corresponds with the severity of illness and members' benefit coverage.
- Innovating UM initiatives designed for cost containment and quality enhancement.
- Ensuring compliance with CMS Model of Care (MOC) requirements.
- Maintaining adequate staffing levels.
- Ensuring comprehensive training and ongoing education for both clinical and non-clinical UM personnel.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
