We have other current jobs related to this field that you can find below

  • Clinical Auditor/Trainer

    2 months ago

    New York, United States MJHS Full time

    Job DescriptionJob DescriptionThe challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help...

  • RN Clinical Auditor/Trainer

    1 month ago

    New York, New York, United States MJHS Full time

    Job Description:Job Description The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep...

  • Ignite Clinical Study Team Lead

    2 weeks ago

    New York, New York, United States Pfizer Full time

    ROLE SUMMARYPfizer Ignite service collaborations expand the way Pfizer works together with biopharmaceutical partners (Partners) to advance innovative therapies. Pfizer Ignite offers unique differentiated service capabilities with global scale and capacity, industry leading speed and quality to quickly develop quality assets, and one-stop shop with expertise...

  • Pfizer Ignite Clinical Study Team Lead

    2 weeks ago

    New York City, United States Pfizer Full time

    ROLE SUMMARYPfizer Ignite service collaborations expand the way Pfizer works together with biopharmaceutical partners (Partners) to advance innovative therapies. Pfizer Ignite offers unique differentiated service capabilities with global scale and capacity, industry leading speed and quality to quickly develop quality assets, and one-stop shop with expertise...

  • Global Clinical Lead

    2 months ago

    New York, New York, United States Pfizer Full time

    The Global Clinical Lead is accountable for late-stage clinical development strategy, oversight and execution. The successful candidate will support multiple early-stage assets for heart failure and other cardiovascular indications, and be responsible for defining the late stage clinical development plan for each asset, working closely with therapeutic area...

  • Clinical Monitoring Lead

    4 days ago

    New York, New York, United States Cordis Full time

    OverviewCordis is at the forefront of medical technology, dedicated to innovative solutions for cardiovascular and peripheral vascular conditions. Our premier product, SELUTION, merges pharmaceuticals with a conventional balloon catheter, transforming the treatment landscape for coronary and peripheral artery ailments. With multiple Investigational Device...

  • Certified Clinical Support Specialist

    4 days ago

    New York, New York, United States Brooklyn Clinical Research Full time

    Position Overview: We are looking for a committed and growth-focused Certified Medical Assistant to become a vital part of our clinical research team. This role is perfect for individuals eager to gain valuable experience in the realm of clinical studies and to further their career in this dynamic field.Company Background: Brooklyn Clinical Research is...

  • Clinical Research Coordinator II

    2 months ago

    New York, United States DM Clinical Research Full time

    Job DescriptionJob DescriptionClinic Research Coordinator II The Clinical Research Coordinator II, will ensure that quality research is conducted at the assigned investigative sites in accordance with the sponsor protocol, FDA Regulations, and ICH/GCP guidelines and to provide the best quality data to the sponsor. The CRC I will also ensure study...

  • RN Utilization Management Nurse

    2 months ago

    New York, United States Amida Care Full time

    Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This...

  • RN Utilization Management Nurse

    1 month ago

    New York, United States Amida Care Full time

    Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This...

  • Clinical Monitoring Lead

    4 days ago

    New York, New York, United States Cordis Full time

    OverviewCordis is at the forefront of medical technology, focusing on innovative solutions for cardiovascular and peripheral vascular conditions. Our leading product, SELUTION, integrates pharmaceuticals with a conventional balloon catheter, transforming the treatment landscape for coronary and peripheral artery diseases. With multiple Investigational Device...

  • Unblinded Clinical Research Coordinator I

    2 days ago

    New York, United States DM Clinical Research Full time

    Job DescriptionJob DescriptionUnblinded Clinical Research Coordinator IDM Clinical Research is looking to hire an Unblinded Clinical Research Coordinator to join our team. This individual will be responsible for dispensing Investigational Products (IP) as part of clinical research trials.Duties & Responsibilities:Compound and dispense prescribed IP.    ...

  • Lead Medical Assistant

    12 hours ago

    New York, New York, United States Bethany Medical Clinic Full time

    Bethany Medical Clinic is seeking a dedicated and experienced Site Lead Medical Assistant to oversee our clinic operations and lead a team of medical professionals. As a Site Lead, you will play a crucial role in ensuring the smooth functioning of our clinic. Your responsibilities will encompass both front desk and clinical duties, requiring a comprehensive...

  • Lead Clinical Embryologist

    4 days ago

    New York, New York, United States US Fertility Full time

    About US Fertility:US Fertility is a leading organization in reproductive health, dedicated to providing exceptional care and innovative solutions in the field of fertility. We are currently seeking a highly skilled Embryologist to join our advanced clinical laboratory team.Position Overview:The Embryologist will play a crucial role in our laboratory...

  • Certified Medical Assistant

    4 weeks ago

    New York, United States Brooklyn Clinical Research Full time

    Location: Brooklyn, NY (Flatbush)Job Type: Full-timeCompany History: Brooklyn Clinical Research was founded to increase access to clinical trials for underrepresented populations. Clinical-trial enrollment should accurately represent the broader population. To support this objective, we establish clinical research sites in densely populated metropolitan...

  • Certified Medical Assistant

    4 weeks ago

    New York, United States Brooklyn Clinical Research Full time

    Location: Brooklyn, NY (Flatbush)Job Type: Full-timeCompany History: Brooklyn Clinical Research was founded to increase access to clinical trials for underrepresented populations. Clinical-trial enrollment should accurately represent the broader population. To support this objective, we establish clinical research sites in densely populated metropolitan...

  • Lead Clinical Laboratory Specialist

    4 days ago

    New York, New York, United States NewYork-Presbyterian Hospital Full time

    Location:New York, New YorkShift:Day (United States of America)Overview:Join a team of dedicated professionals at NewYork-Presbyterian Hospital, where Laboratory Specialists are pushing the boundaries of science and healthcare.Role Summary:As a Lead Clinical Laboratory Specialist, you will play a pivotal role in our Hematology department within the Central...

  • Care Manager

    2 weeks ago

    New York, United States Pride Health Full time

    We're looking for Care Manager - RN for our client with a leading hospital in New York, NY. Please find below details of the position.Position: Care Manager - RNLocation: New York, NYDuration: 3 months contract with extension possibilities.Shift: Days 8 hour shiftPay - $52/hrJob Duties:The Care Manager develops, facilitates, monitors, and communicates a care...

  • Clinical Team Leader

    4 days ago

    New York, New York, United States Rochester Regional Health Full time

    OUR COMMITMENT TO YOU:At Rochester Regional Health, we prioritize excellence in healthcare. Our comprehensive benefits and rewards programs promote employee wellness, career advancement, and personal development.We support your professional journey while enhancing community health.Sign-on BonusPaid Time OffRelocation SupportBenefits Effective...

  • Senior Clinical Research Associate

    2 months ago

    New York City, United States Worldwide Clinical Trials - USA Full time

    Who we are Worldwide Clinical Trials (Worldwide), a leading global contract research organization (CRO), works in partnership with biotechnology and pharmaceutical companies to create customized solutions that advance new medications - from discovery to reality. Anchored in our company’s scientific heritage, our dedicated therapeutic focus on...

UM Clinical Team Lead

2 months ago

New York, United States NYC Health Hospitals Full time

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Utilization Management (UM) Clinical Team Lead, under the direction of the Director of Utilization Management provides oversight of the administration of departmental utilization management activities.

Job Description

  • Supervise staff conduct utilization review.
  • Oversee utilization review activities and ensures cases are reviewed timely meeting NYS DOH and CMS regulatory standards.
  • Support care management team development through direct staff training and development activities
  • Conduct utilization review and quality of care monitoring activities in conjunction with care management program staff
  • Quarterly audits of clinical staff
  • Investigation and resolution of clinical claims related issues
  • Support departmental training and clinical quality improvement activities.
  • Participate in the development, implementation, and evaluation of performance improvement initiatives
  • Ensure that standards of care delivery are consistent with current professional standards and consistent with the Mission, Vision and Values of the organization.
  • Actively participate in Article 44/49 and CMS audit activities
  • Participate in committees, as assigned.
  • Other responsibilities as directed by the Director of Utilization Management or Vice President of Clinical Services.
Minimum Qualifications
  • High School Degree or General Equivalency Diploma (GED) required
  • At least 4 years of Utilization Management experience required.
  • Strong working knowledge of InterQual required.
  • At least 1 year of supervisory experience.
  • Computer literacy and excellent written and oral communication skills required
  • Registered Nurse with a current New York State License, Licensed Practical Nurse, or Physician Assistant with significant managed care experience.
Professional Competencies
  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communications
  • Ability to work in a fast-paced environment.
  • High degree of diplomacy and tact

#LI-REMOTE