Director of BD&L Biosimilars identifying and managing Biosimilar assets for international regions. Leading evaluations, negotiations, and overseeing regional portfolio management for Sandoz.
About the role
- Director of Utilization Management overseeing clinical operations to ensure quality care and efficiency. Leading teams through strategic direction and compliance in a regulated environment.
Responsibilities
- Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests
- Develop strong operational and leadership capabilities within the organization through performance improvement, career development, and coaching
- Develop and implement policies and procedures that align with industry standards, payer guidelines, and regulatory requirements
- Deliver on Healthfirst’s Mission by ensuring optimum quality of member care in a cost-effective manner
- Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health (DOH), and other oversight entities
- Develop and monitor appropriate metrics to maintain and improve department performance
- Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement
- Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program, sometimes through the implementation of new technology
- Serve as the operational subject matter expert on business development efforts related to UM programs, including the launch of new products or regulatory initiatives
- Collaborate closely with other Operations leaders including but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions
- Partner with technology and data teams to refine data governance and reporting, inform AI use cases, and performance monitoring frameworks
- Support organizational change management for UM modernization efforts, fostering engagement, communication, and adoption of new technologies or processes
- Advocate and actively participate as the clinical voice on various clinical committees and other clinical policy workgroups
Requirements
- Bachelor’s degree in healthcare, business, or a related field from an accredited institution or equivalent work experience
- Progressive leadership experience in healthcare management including work experience in a mid-senior management role
- Work experience and deep familiarity of health plans such as Medicare, Medicaid and/or Managed Long-Term Care Plan (MLTCP).
- Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations
- Work experience interpreting and operationalizing regulatory updates and guidance from DOH and CMS.
- Work experience demonstrating written and verbal communication skills with the ability to influence and collaborate across all levels and functions.
- Demonstrated success driving high performance and quality outcomes in a fast-paced, regulated environment.
Benefits
- medical, dental and vision coverage
- incentive and recognition programs
- life insurance
- 401k contributions
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Director of Nursing at Johns Island Post Acute leading nursing staff and ensuring exceptional resident care. Foster a collaborative environment while ensuring compliance with regulations.
Director of Loyalty Strategy delivering aligned marketing strategies for travel brands at Expedia Group. Leading global loyalty programs to enhance traveler relationships and engagement.
Strategic director responsible for defining and leading Hearing Functions at Sonova. Fostering innovation and cross - functional collaboration for hearing aid technology and solutions.
Associate Director developing External Innovation strategy for Cardiovascular & Women’s Health at Eli Lilly. Collaborating with partners and evaluating innovative opportunities in the pharmaceutical industry.
Senior Director driving business excellence in External Expert Engagement at Novartis. Responsible for strategic design, integration, and improvement of global standards and processes.
Senior Director of Facilities and Maintenance focused on category strategies for growth and customer acquisition. Leading cross - functional teams and optimizing supplier relationships for effective product management.
Practice Director responsible for $20M Oracle ERP deal closures. Collaborating within Oracle ecosystem and positioning Birlasoft as a preferred partner in Texas.
Director of Technology Lending overseeing technology roadmap and servicing of securities - based lending products at RBC Bank, ensuring operational resiliency and collaboration with various teams.
Principal Director overseeing NASA Space Technology Directorate at Aerospace Corporation. Leading engineering activities and strategic initiatives for NASA customers across multiple locations.