Utilization Management Director

Job Overview: The Director of Utilization Management (RN) develops, oversees, and directs the Utilization Management Department. Candidate leads and directs the utilization review staff and program while promoting the success of Utilization Management functions through care coordination. Additionally, determines policies and procedures that incorporate best practices and ensures effective utilization reviews. Essential Responsibilities: • Provides day-to-day oversight of Utilization Management operations, ensuring all practices and programs are aligned with the management team, directs the policies and procedures, and standards for utilization management operations.• Develops utilization management policies, consistent with all Medicare requirements• Reviews CMS, InterQual, and DOH guidelines to determine if updates are needed for Utilization Management department and workflows• Provides leadership utilization management policy initiatives and Implement modifications and improvements to existing programs as needed.• Develops processes, trainings, and protocols for the Utilizations Review team• Ensures compliance, timeliness, and completeness of Care Plans• Training of new hires, ongoing re-training of staff• Prepares agenda and leads team regularly scheduled meetings• Monitors utilization reports, identifying changes in utilization and overall trends• Documents case review findings, actions, and outcomes in accordance with Utilization Management policies• Manages the development and implementation of effective utilization management strategies.• Directs the efforts of the utilization review, case management, and pre- certification functions to accomplish objectives within policy and budget.• Performs all assigned tasks and projects• Determines staff needed to support U/M and appeals processes Required Education, Experience, and Licenses: • 3+ years' experience in a senior management role.• Utilization Management experience required.• NYS licensed RN. Benefits: Medical, dental, and vision insurance Generous PTO package Multiple floating holidays 401 (K) with employer contribution