Manager of Clinical Business Operations

About the role

Reporting to the Director of Utilization Management, the Manager of Clinical Business Operations ensures Utilization Management non-clinical operations meet CMS and NYSDOH requirements while supporting departmental quality assurance and business objectives. You will guide non-clinical staff performance, translate regulatory expectations into workable processes, and help drive consistent, audit-ready outcomes.

Responsibilities

• Monitor non-clinical productivity and deliverables
• Support utilization management projects and departmental initiatives tied to regulatory alignment
• Develop and update policies and communicate operational impacts to upstream and downstream stakeholders
• Provide administrative subject matter expertise
• Contribute to corrective action plans
• Identify operational risks and partner on mitigation plans
• Support additional initiatives as directed

Required Qualifications

• 3+ years in Utilization Management/Managed Care with Medicare/Medicaid UM quality monitoring and regulatory processes (non-clinical)
• Strong leadership, communication, and stakeholder-management skills
• Ability to analyze data, measure outcomes, and escalate action plans
• Comfort working quickly, prioritizing effectively, and meeting deadlines
• Strong computer/software proficiency
• Bachelor’s degree preferred

Schedule

Monday – Friday, 9:00 am – 5:00 pm

Pay

$118,135.58 – $132,902.53 annual salary

Location

Hybrid; must reside in NY, NJ, or CT