Director of Utilization Management

Director of Utilization Management

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.

The Director of Utilization Management (UM) at VillageCare plays a pivotal role in overseeing the daily operations of the UM Department, encompassing critical areas such as inpatient, outpatient, and long-term support service reviews. This leadership position involves managing transitions of care and discharge planning, ensuring that outpatient services align with the VillageCareMAX benefit profile. The Director will develop and direct annual departmental programs and monitor key performance indicators to promote effective utilization management functions. Focused on delivering quality, medically appropriate care that corresponds with the severity of illness and members' benefit coverage, the role also involves innovating UM initiatives designed for cost containment and quality enhancement. Additionally, compliance with CMS Model of Care (MOC) requirements is essential.

The Director is responsible for maintaining adequate staffing levels and ensuring comprehensive training and ongoing education for both clinical and non-clinical UM personnel, thereby fostering a skilled and efficient team.

To excel as the Director of Utilization Management at VillageCare, candidates must possess a robust skill set that combines leadership, analytical, and healthcare management capabilities. A minimum of five years of management experience in a health-related field, alongside three years in a quality management role, is essential for navigating the complexities of utilization management. Proficiency in analyzing data to drive improvement activities is crucial, as is a deep understanding of the regulatory structures governing quality management within Medicare and Medicaid health plans. Candidates should hold a Bachelor's Degree, with a preference for a Master's Degree, and must have an active NYS (RN) License or be willing to obtain it within three months of hire.

Strong communication and interpersonal skills are necessary for effective collaboration and to foster a culture of excellence within the team, ensuring optimal patient care and compliance with industry standards.

Knowledge and skills required for the position are:

• 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. Master's degree preferred
• Active NYS (RN) License or willing to obtain within 3 months of hire required

If you believe that this position matches your requirements, applying for it is a breeze. Best of luck!