Senior Director leading global talent enablement in S&C Electric Company's HR department. Ensuring organizational, professional, and career development aligned with strategic objectives.
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
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