Vice President, Utilization Management
Confidential
Vice President, Utilization Management
About the Company
Pioneering continuing care organization for individuals with chronic care needs
Industry
Hospital & Health Care
Type
Non Profit
Founded
1977
Employees
1001-5000
Categories
- Health Care
Specialties
- managed long term care
- nyc
- chronic care needs
- rehabilitation
- care management
- medicare
- medicaid
- health
- seniorcare
- healthcare
- and health plans
Business Classifications
- B2C
- B2B
About the Role
The Company is seeking a Vice President for Utilization Management to lead the development and implementation of strategic plans that optimize the end-to-end operations of all utilization management functions. The successful candidate will be responsible for ensuring access to necessary services for all members while effectively managing costs. This role involves leading a team of experienced professionals in assessing member needs against clinical guidelines across various service settings and ensuring compliance with Medicare and Medicaid program rules. The Vice President will work in a matrix environment, closely collaborating with senior leaders in finance, medical economics, data analytics, care management, pharmacy management, network management, and behavioral health management to integrate utilization management functions within the clinical operations team, with a focus on achieving positive clinical outcomes and enhancing member satisfaction. Applicants for the Vice President, Utilization Management position at the company should have a minimum of 8 years' management experience in a health-related field, with at least 10 years in a utilization management role. Hospital-based clinical experience is required, as is a proven track record of successful management of UM functions in compliance with Medicare and Medicaid rules. The role demands a candidate with a Bachelor's degree in nursing and a Master's degree in a related healthcare or business field. The ideal candidate will have a strong background in analyzing and using data to drive improvement activities and will be adept at leading a team in a dynamic, community-based healthcare environment. The focus of the role is on continuous review and refinement of utilization management strategies and plans to ensure the highest quality of care for members.
Hiring Manager Title
EVP for Clinical Services and Network Management
Functions
- Medical Care/Hospital Administration
- Operations
$201.81k - $227.03k
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Confidential
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