Program Director (Utilization Management) Licensed - Mount Sinai Health Partners

Mount Sinai Health System•New York, NY

About The Position

The Program Director (Licensed) is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and value-based care populations. This role drives cost-effective, high-quality post-acute care through strategic partnerships, data-driven performance oversight, clinical and operational leadership, and strong collaboration with internal and external stakeholders across the care continuum. The role requires a proactive leader with strong clinical insight, analytical capabilities, and change management expertise who can operate effectively in a fast-paced environment. This position reports to the VP of Care Transitions of Mount Sinai Health System.

Requirements

Master’s or greater in Nursing, Bachelor’s or greater in Physical Therapy or Occupational Therapy
7+ years of experience in care management, utilization management, population health, or value-based care.
Demonstrated experience working with ACOs, SNFs, and post-acute care networks.
Current NYS licensure (Nursing, Physical Therapy, Occupational Therapy or related profession)
Demonstrated interpersonal and leadership and organizational skills.
Analytic ability to collect and organize information, identifies problems and trends, and formulate and implement corrective plans and programs.
Ability to develop, coordinate, prioritize and allocate resources.
Proven ability to lead complex initiatives with limited resources.
Excellent communication, relationship-building, and presentation skills.
Advanced MS Office Suite Skills

Responsibilities

Lead, expand, and sustain the SNF Utilization Management Initiative across a network of 90+ SNF partners.
Support post-acute clinical coordinators by escalating to SNF leadership to expedite patient discharge when clinically appropriate and safe.
Ensure continuity of program operations during staffing changes through cross-training and workflow optimization.
Monitor ACO and value-based contract performance using Tableau dashboards, CarePort Insight, and internal reporting tools.
Develop, refine, and implement performance improvement strategies to ensure SNFs meet or exceed target benchmarks.
Deliver comprehensive monthly performance reports to executive leadership, including the VP of Care Transitions and CMO.
Track and report on key performance indicators (KPIs), including utilization, length of stay, discharge disposition, and preferred provider use.
Oversee utilization management strategies to ensure appropriate levels of care at discharge.
Maintain reduced Certified Home Health Agency (CHHA) utilization rates, matching or exceeding organizational benchmarks.
Collaborate with payers and SNF leadership to ensure appropriate authorization processes and optimized lengths of stay for short-term skilled services.
Provide clinical oversight to Transitional Care Coordinators to ensure appropriate discharge planning and higher rates of home discharge.
Support and optimize workflows, documentation, and reporting within Epic.
Ensure staff adherence to standardized workflows, clinical appropriateness, and regulatory requirements.
Maintain and strengthen partnerships with skilled nursing facilities, part B vendors, CHHAs, long-term home care agencies and hospice providers.
Lead Joint Operating Committee (JOC) meetings and provide ongoing performance updates and ad-hoc consultations.
Sustain strong payer relationships to support utilization management goals.
Monitor and report on ACO discharges to preferred vs. non-preferred SNFs.
Share performance feedback with hospital leadership to reinforce preferred provider utilization.
Lead in-person and virtual education sessions for social workers, case managers, and interdisciplinary inpatient teams.
Develop and maintain orientation and educational materials focused on: o Discharge to home o Preferred provider utilization o Available transitional care resources (e.g., TOCC/NCC)
Lead rapid operational restructuring in response to staffing or organizational changes.
Develop and maintain training materials, tip sheets, disclaimers, and Epic-integrated resources.
Partner with Communications to ensure initiatives are accurately represented internally and externally.
Evaluate workflows and processes continuously to improve efficiency, productivity, and outcomes.
Foster a culture of openness, trust, inclusivity, and accountability.
Lead monthly team meetings and individual check-ins to align goals and co-create performance strategies.
Train, retrain, and onboard staff to new workflows, ensuring operational stability during transitions (e.g., leaves of absence).
Provide constructive feedback, coaching, and hands-on support to drive high performance and engagement.
Support staff cross-training to ensure adequate coverage and continuity of care.
Perform other responsibilities as assigned