Associate Director of Operations leading operational performance and service delivery at Concentrix. Responsible for managing budgets, recruiting, and ensuring compliance across various projects in a dynamic environment.
About the role
- Senior Manager overseeing Clinical Utilization Management operations at Healthfirst. Ensuring compliance and excellence in medical necessity reviews and service authorizations.
Responsibilities
- Provide strategic oversight and operational management for all utilization management functions, including prior authorization, concurrent review, and service requests
- Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, clinicians, and coordinators
- Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health (DOH), and other oversight entities
- Establish, monitor, and report on key performance indicators (KPIs), productivity, and quality metrics to ensure compliance and optimal performance
- Partner with Clinical Operations, Quality, Compliance, and Provider Relations to ensure alignment and effective communication across departments
- Utilize data analytics and reporting tools to identify trends, drive process improvements, and optimize resource allocation
- Lead readiness efforts for audits, performance improvement plans, and corrective actions related to utilization management
- Foster a culture of accountability, professional development, and continuous improvement across all levels of the team
- Serve as a subject matter expert and escalation point for complex or high-impact cases requiring clinical and operational judgment
- Support system implementations and technology enhancements to improve automation, reporting, and member/provider experience
- Ensure the department maintains timely and accurate completion of service authorizations and reviews in alignment with turnaround time standards
- Additional duties as assigned
Requirements
- Bachelor’s degree in Nursing, Healthcare Administration, or a related field from an accredited institution or equivalent work experience
- NYS RN
- Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations
- Leadership experience in managing, coaching and developing multidisciplinary clinical teams
- Strong analytical, organizational, and problem-solving skills
- Work experience demonstrating written and verbal communication skills with the ability to influence and collaborate across 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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