Position: Director of Utilization Management

Location: Hybrid (Must Reside in NY/NJ/CT)

Work Schedule: Monday - Friday, 9:00am - 5:00pm

Compensation: $118,135.58 - $132,902.53 Annual Salary

Day to day as a Director of Utilization Management

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.
Are you the Director of Utilization Management we're looking for?

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

Your next step

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