Job Description
**Duties/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 Healthfirsts 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...
+ 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 Healthfirsts 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...