Utilization Management Manager

Description and RequirementsThe Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN's, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to Healthfirst's care management team, members, and outside medical providers.Duties/Responsibilities:Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan servicesDevelops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisionsCollaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problemsAllocate, monitor, and control resources while delegating and monitoring workloadsDevelops and analyzes operational and analytical reports to monitor and track operational efficiencyProperly documents utilization management activities and rationale for all decisions in electronic medical records systemsFunctions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost managementAdditional duties as assignedMinimum Qualifications:Associate's degreeRN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical licenseWork experience demonstrating verbal and written communication skillsExperience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneouslyExperience with Microsoft Office Suite applications including Exce