New York Licensed UM Director

Job Summary

A company is looking for a UM Director Clinical Operations to oversee utilization management and improve healthcare service delivery.

Key Responsibilities

• Advance modernization of utilization management and implement strategic process improvements
• Drive operational performance and establish best practices for monitoring performance metrics
• Collaborate with internal and external stakeholders to improve care coordination and health outcomes

Required Qualifications, Training, and Education

• Bachelor's Degree; RN with Master's degree preferred
• 10+ years of experience in a Managed Care Environment with expertise in Utilization Management
• At least 7 years of clinical and disease management experience
• Proven experience in managing care and disease management programs
• Ability to interpret guidelines to control medical costs effectively