Vice President of Utilization Management

Village Care • New York, NY

3d • Hybrid

About The Position

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.

The Vice President, Utilization Management is responsible for the development and implementation of plans to optimize the end to end operations of all utilization management functions to ensure access to needed services for all members while managing costs. Reporting to the EVP for Clinical Services and Network Management and working in collaboration with the Senior Medical Director, the Vice President, Utilization Management leads a team of experienced professionals responsible for assessing member needs relative to applicable clinical guidelines across the full range of inpatient, outpatient, and home-based services, and for ensuring compliance with Medicare and Medicaid program rules and requirements. The Vice President, Utilization Management, through a matrix environment, works closely with senior leaders responsible for, Finance, Medical Economics, Data Analytics, Care Management, Pharmacy Management, Network Management and Behavioral Health Management programs to effect the integration of Utilization Management functions within the Clinical Operations team, seeking to achieve positive clinical outcomes and enhance member satisfaction across all VillageCareMAX lines of business. The Vice President, Utilization Management is responsible for the ongoing review and refinement of Utilization Management strategies and plans.

Requirements

• A minimum of 8 years management experience in a health-related field
• A minimum of 10 years' experience in a utilization management position
• Hospital based clinical experience required
• Experience analyzing and using data to drive improvement activities
• Track record of successful management of UM functions in compliance with Medicare and Medicaid rules and requirements
• Bachelor's Degree in Nursing
• Master's degree in related healthcare or business field required

Responsibilities

• Development and implementation of plans to optimize end-to-end operations of all utilization management functions.
• Ensuring access to needed services for all members while managing costs.
• Leading a team of experienced professionals responsible for assessing member needs relative to applicable clinical guidelines across the full range of inpatient, outpatient, and home-based services.
• Ensuring compliance with Medicare and Medicaid program rules and requirements.
• Working closely with senior leaders responsible for Finance, Medical Economics, Data Analytics, Care Management, Pharmacy Management, Network Management and Behavioral Health Management programs to effect the integration of Utilization Management functions within the Clinical Operations team.
• Seeking to achieve positive clinical outcomes and enhance member satisfaction across all VillageCareMAX lines of business.
• Ongoing review and refinement of Utilization Management strategies and plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive