Utilization Management Manager

Duties/Responsibilities

• Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan services
• Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions
• Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems
• Allocates, monitors, and controls resources while delegating and monitoring workloads
• Develops and analyzes operational and analytical reports to monitor and track operational efficiency
• Properly documents utilization management activities and rationale for all decisions in electronic medical records systems
• Fulfills the role as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management

Requirements

• Minimum Qualifications: Associate’s degree, RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
• Work experience demonstrating verbal and written communication skills
• Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
• Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook
• Preferred Qualifications: Master’s degree in a related discipline, Certified Case Manager, Interqual, Milliman, and/or TruCare knowledge, Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care, Experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services, Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies

Qualifications

• Minimum Qualifications: Associate’s degree, RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
• Work experience demonstrating verbal and written communication skills
• Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
• Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook
• Preferred Qualifications: Master’s degree in a related discipline, Certified Case Manager, Interqual, Milliman, and/or TruCare knowledge, Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care, Experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services, Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies

Skills

• Verbal and written communication skills
• Problem-solving skills
• Handling multiple priorities simultaneously
• Microsoft Office Suite applications including Excel, Word, Power Point and Outlook
• Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
• Experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services
• Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies

Benefits

• Medical, dental and vision coverage
• Incentive and recognition programs
• Life insurance
• 401k contributions

Pay

• Hiring Range: Greater New York City Area (NY, NJ, CT residents): $116,800 - $168,810
• All Other Locations (within approved locations): $99,700 - $148,325

Schedule

• Not specified