Utilization Management Director jobs in New York

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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System Director of Utilization and Care Management
  • Cayuga Medical Center
  • Ithaca, NY FULL_TIME

  • Job Description

    Job Title: System Director of Utilization and Care Management

    Department: Clinical Resource Management

    Reports To: Senior Director, Care Transitions

    Job Summary: Cayuga Health System seeks a highly motivated and goal-oriented Director of Utilization and Care Management responsible for providing oversight and broad direction to Case Management, Social Services, Utilization Management and Clinical Documentation Improvement/Integrity. The System Director of Care and Utilization Management works closely with CHS leadership - in particular Nursing, Patient Access/Accounting, Revenue Cycle, Information Systems, and Performance Optimization - to support patient progression and optimize outcomes affecting clinical, operational, and financial performance.

    Job Responsibilities include:

    • Monitor and identify trends in practices, utilization, and reimbursement that may present financial risk to CHS; develop plans to reduce/eliminate respective risks.
    • Identify educational opportunities for team members to increase understanding of CM/UM concepts and trends, streamline activities, and improve patient outcomes.
    • Strategic and proactive hiring, performance management and coaching to enhance professional development and optimization of skillsets.
    • Develop, implement, and annually review the CHS Utilization Management Plan; works with provider chairs to facilitate Utilization Review Committee meetings.
    • Ensure compliance with business ethics, state and federal regulatory requirements, and organizational policies and procedures among direct reports.
    • Evaluation and recommendation of vendor/contractual services to support denial management and other departmental activities.
    • Maintain knowledge of complex clinical guidelines and medical management policies published by payers; communicates relevant clinical requirements to ensure documentation is optimal and succinct.
    • Demonstrate the willingness and ability to work collaboratively with key internal and external teams, both clinically and administratively to obtain necessary information to promote outcomes and readily address revenue cycle and denial management opportunities and concerns.
    • Demonstrate strong written and verbal communication skills. Enforces appropriate written and verbal communication among team members.
    • Develop and implement feedback and educational initiatives for denial prevention activities as indicated.
    • Work with area supervisors to streamline communications, processes, and role definitions within the department.
    • Design and implement process to readily track and report relevant UM/CDI/Denials Management functions inclusive of but not limited to:
    • CDI Impact, Query rates and responses
    • MOON and IMM Compliance data
    • DRG Downgrades
    • Length of stay and avoidable delays
    • Maintain budgetary duties as assigned.
    • Exemplify satisfactory attendance and punctuality record as set forth by CHS policies.
    • Exemplify a professional image in appearance, manner and presentation.
    • Maintains patient confidentiality in the provision of quality care.
    • Is flexible in assuming other appropriate responsibilities not noted above.

    Requirements:

    Education - Masters of Nursing, Healthcare Administration, or related field required.

    Experience - Minimum 5 years of experience in acute hospital setting, minimum of 3 years in leadership. Minimum 3 years of experience with utilization and denials management. Knowledge of discharge planning and clinical case management strategies. Knowledge and experience in project management and team dynamics. Outstanding leadership, analytical, negotiation and conflict resolution skill. Knowledge and experience in developing utilization management and revenue recovery strategies. Highly motivated and goal orient. Demonstrated knowledge and experience in developing utilization management and revenue recovery strategies. Demonstrated ability to implement change and lead effective teams.

    Physical - Ability to stand, sit or ambulate for long periods. Ability to mobilize freely around units, transport self to site locations, and perform required data entry into EMR and alternate data management systems.



    • Indicates Essential functions

    Cayuga Health System Commitment to Diversity, Equity & Inclusion

    Cayuga Health System commits to treat all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.

    Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees


  • 24 Days Ago

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Utilization Management Nurse
  • Brighton Health Plan Solutions, LLC
  • New York, NY FULL_TIME
  • About The Role The Medical Utilization Management Nurse is responsible for medical necessity review of services that require prior authorization. The medical necessity review process includes assessme...
  • 20 Days Ago

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Physician Advisor Utilization Management
  • Crouse Hospital
  • Syracuse, NY FULL_TIME
  • Conducts clinical review on cases referred by case management staff and/or other health care professionals in accordance with the hospitals Utilization Review guidelines to ensure efficient utilizatio...
  • 22 Days Ago

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Utilization Management Reviewer
  • iCircle - Wolf Center
  • Webster, NY FULL_TIME
  • Summary: Utilization Management Reviewer (UR) is the critical evaluation of health care services provided to members using an integrated approach to determine the necessity and appropriateness of thos...
  • Just Posted

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UTILIZATION MANAGEMENT SPECIALIST
  • FLACRA
  • Clifton Springs, NY FULL_TIME
  • Job Summary: In accordance with the organization’s mission, vision and values, the Utilization Management Specialist is responsible for evaluation of the medical necessity, appropriateness, and effici...
  • 4 Days Ago

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Utilization Management Coordinator
  • Rochester Regional Health Careers
  • Rochester, NY FULL_TIME
  • HOW WE CARE FOR YOU:At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal ...
  • 5 Days Ago

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Managing Director
  • SpartaCraft
  • Connelly Springs, NC
  • Job Description Job Description SpartaCraft, a contract wood products and finishing company in Connelly Springs, NC is l...
  • 3/28/2024 12:00:00 AM

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Managing Director
  • Chapman Associates, Inc.
  • Chapman Associates is a Mergers & Acquisitions association focused on middle-market strategic acquisitions on the buy an...
  • 3/28/2024 12:00:00 AM

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Managing Director
  • Artech L.L.C.
  • Fremont, CA
  • Artech is currently looking to hire an experienced Managing Director to join our expanding team in Fremont, CA (Hybrid)....
  • 3/28/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Artech L.L.C.
  • Fremont, CA
  • Artech is currently looking to hire an experienced Managing Director to join our expanding team in Fremont, CA (Hybrid)....
  • 3/25/2024 12:00:00 AM

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Managing Director Relationship Manager-MMB
  • First Citizens Bank
  • Santa Monica, CA
  • Overview: First Citizens Middle Market Banking delivers a range of financial solutions to midsize clients through a rela...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Transamerica Premier Life Insurance Company
  • Nashville, TN
  • The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Selby Jennings
  • Chicago, IL
  • Join a dynamic and growing team at our Client; A premier financial services firm specializing in middle-market transacti...
  • 3/24/2024 12:00:00 AM

New York is a state in the Northeastern United States. New York was one of the original thirteen colonies that formed the United States. New York covers 54,555 square miles (141,300 km2) and ranks as the 27th largest state by size.[3] The highest elevation in New York is Mount Marcy in the Adirondacks, at 5,344 feet (1,629 meters) above sea level; while the state's lowest point is at sea level, on the Atlantic Ocean. In contrast with New York City's urban landscape, the vast majority of the state's geographic area is dominated by meadows, forests, rivers, farms, mountains, and lakes. Most of...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$134,764 to $182,225

Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
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Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
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Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019