Director Utilization Management
Bassett Healthcare Network•Village of Cooperstown, NY
•Hybrid
About The Position
Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible.
Requirements
- 4 Year / Bachelor's Degree In Nursing (BSN), required
- Minimum 7 years of combined experience required in: Utilization Review, Case Management
- Minimum 5 years of experience in progressive healthcare leadership; multi-hospital and vendor oversight preferred
- NYS Licensure as a Registered Nurse (RN) required
Nice To Haves
- Master's Degree In one of the following preferred: Nursing (MSN), Healthcare Administration (MHA), Business Administration (MBA)
- ACM - Accredited Case Manager preferred
- CCM - Certified Case Manager preferred
- CMAC - Case Management Administrator Certification peferred
Responsibilities
- Provides strategic oversight of system-wide utilization management programs to optimize reimbursement, regulatory compliance, patient status determination, and resource utilization.
- Directs and evaluates contracted utilization management vendor performance, including productivity, quality, staffing, contractual compliance, and operational improvement initiatives.
- Develops and implements utilization management policies, workflows, and best practices across the healthcare network.
- Oversee medical necessity review processes, denial prevention strategies, payer audit support, and appeals management activities.
- Partners with Physician Advisors, CDI, and operational leaders to improve documentation quality, status determination accuracy, observation management, and length-of-stay performance.
- Collaborates with Revenue Cycle leadership to identify and implement opportunities that improve reimbursement and reduce avoidable denials.
- Develops and oversees utilization management analytics, dashboards, scorecards, and key performance indicators to support data-driven decision-making.
- Analyzes utilization trends, financial outcomes, and operational performance to identify system-wide improvement opportunities.
- Ensures compliance with CMS, Medicare, Medicaid, commercial payer requirements, InterQual, MCG, and accreditation standards.
- Build collaborative relationships with physicians, clinical leaders, and operational departments to promote organizational goals and performance improvement.
- Provides education and consultative support regarding medical necessity, documentation requirements, utilization management regulations, and payer expectations.
- Performs similar or related duties as requested or directed.
Benefits
- Paid time off, including company holidays, vacation, and sick time
- Medical, dental and vision insurance
- Life insurance and disability protection
- Retirement benefits including an employer match
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What This Job Offers
Job Type
Full-time
Career Level
Director
