Utilization Manager

2 weeks ago


New York, New York, United States LESC Full time
Job Summary

We are seeking a highly skilled Utilization Manager to join our team at LESC. The successful candidate will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements.

Key Responsibilities
  • Collaborate with CASAC Counselors and supervisory staff to ensure compliance with external and internal utilization review/quality and appropriateness requirements.
  • Communicate effectively with external case managers at referring provider facilities and/or managed care organizations (MCO) for data collection, interpretation, and certification/recertification from third-party payers.
  • Conduct ongoing medical necessity reviews, which may be pre-service, concurrent, and/or retrospective in nature, by evaluating clinical data and submitting appropriate documentation to update the patient/resident's status to the MCO as scheduled.
  • Act as a liaison between the residential program and the MCO to facilitate the reimbursement process.
  • Referring MCO denials and non-covered medical services to the directors for appeal determination and next steps.
  • Conduct timely and complete quality and appropriateness reviews on a representative sample of treatment records for residential service sites.
  • Provide supervisory support to CASAC Counselors and Peer Workers as needed with supervisory guidance from Management/Leadership Team.
  • Monitor and evaluate ongoing audit for chart.
  • Provide direct care services to clients as needed.
  • Assist with the maintenance of the agency's OASAS reviews and CARF accreditation for the program, i.e., standards review and conformance auditing.
Requirements
  • Minimum of 2 years of case management and/or utilization review experience.
  • Strong problem-solving and advanced analytical skills necessary to read, understand, interpret, and analyze statistical data.
  • Excellent oral, written, organizational, and interpersonal communication skills.
  • Ability to communicate effectively with senior leadership as well as other clinical/non-clinical directors, managers, staff, consultants, and MCOs.
  • OASAS CASAC Certification (with Bachelor's Degree).
  • Other QHP credential such as LMSW, LMHC, LMSW-LP, or MHC-LP (with Master's Degree).
  • Master's Degree in Social Work or related field.
  • In-depth knowledge on HIPAA, OASAS, and 42 CFR regulations.
  • Working knowledge of quality assurance and utilization review systems.
  • Computer literacy including proficiency in Microsoft Office Suite and HER.
  • Experience working directly with people from diverse racial, ethnic, and socioeconomic backgrounds.
  • Competency in written, interpersonal, verbal, and computational skills to present and document records in accordance with program standards.
  • Ability to work independently.

  • Utilities Manager

    2 days ago


    New York, New York, United States A&E PROPERTIES II MGMT LLC Full time

    {"h1": "Job Title: Utilities Manager", "h2": "Job Summary", "p": "We are seeking a highly skilled Utilities Manager to join our team at A&E Properties II Mgmt LLC. The successful candidate will be responsible for opening and maintaining all utility accounts, ensuring accuracy of the utilities database, and performing various accounting and administrative...

  • Utility Manager

    3 weeks ago


    New York, New York, United States Upward On Full time

    About the OpportunityWe are seeking a highly skilled Utility Manager to join our team at Upward On, a national commercial and residential owner/developer/management company based in Great Neck, NY.The successful candidate will be responsible for leading a team and supervising utility analysts with at least 2 years (3+ years preferred) experience in...

  • Utilities Manager

    2 days ago


    New York, New York, United States A&E PROPERTIES II MGMT LLC Full time

    Job Title: Utilities ManagerA&E Properties II Mgmt LLC is seeking a skilled Utilities Manager to join our team. The successful candidate will be responsible for managing utility accounts, ensuring accurate data entry, and coordinating with internal teams and external service providers.Key Responsibilities:Coordinate with the India Accounts Payable Team and...

  • Utilities Manager

    2 days ago


    New York, New York, United States A&E PROPERTIES II MGMT LLC Full time

    Job Title: Utilities ManagerA&E Properties II Mgmt LLC is seeking a skilled Utilities Manager to join our team. As a key member of our accounting department, you will be responsible for managing utility accounts, ensuring accuracy, and providing exceptional customer service.Key Responsibilities:Coordinate with the India Accounts Payable Team and utility...

  • Utilization Manager

    3 weeks ago


    New York, New York, United States PROMESA R.H.C.F. Full time

    Job Title: Utilization ManagerPromesa R.H.C.F. is seeking a highly skilled Utilization Manager to join our team. As a key member of our healthcare team, you will be responsible for ensuring that our patients receive the highest level of care while also meeting the requirements of managed care organizations.Key Responsibilities:Collaborative Communication:...

  • Utilization Manager

    3 weeks ago


    New York, New York, United States LESC Full time

    Job SummaryLESC is seeking a highly skilled Utilization Manager to join our team. As a key member of our clinical operations team, you will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements.Key ResponsibilitiesCollaborate with external case managers to collect, interpret, and...

  • Utilization Manager

    4 weeks ago


    New York, New York, United States LESC Full time

    Job SummaryWe are seeking a highly skilled Utilization Manager to join our team at LESC. The successful candidate will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements, working closely with CASAC Counselors and supervisory staff.Key ResponsibilitiesCollaborate with external case...

  • Utilization Manager

    3 weeks ago


    New York, New York, United States LESC Full time

    Job SummaryWe are seeking a highly skilled Utilization Manager to join our team at LESC. The successful candidate will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements, working closely with CASAC Counselors and supervisory staff.Key ResponsibilitiesCollaborate with external case...

  • Utilization Manager

    2 days ago


    New York, New York, United States LESC Full time

    Job Title: Utilization ManagerJob Summary:The Utilization Manager will work closely with the agency's mission to provide high-quality care and service delivery to individuals served. This role will assist CASAC Counselors and supervisory staff in ensuring compliance with external and internal utilization review/quality and appropriateness requirements.Key...

  • Utilization Manager

    3 weeks ago


    New York, New York, United States LESC Full time

    Job SummaryWe are seeking a highly skilled Utilization Manager to join our team at LESC. The successful candidate will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements, working closely with CASAC Counselors and supervisory staff.Key ResponsibilitiesCollaborate with external case...

  • Utilization Manager

    2 days ago


    New York, New York, United States LESC Full time

    Job SummaryWe are seeking a highly skilled Utilization Manager to join our team at LESC. The successful candidate will be responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements, working collaboratively with CASAC Counselors and supervisory staff as needed.Key ResponsibilitiesCollaborate with...


  • New York, New York, United States WellSpan Health Full time

    Job SummaryWellSpan Health is seeking a highly skilled and experienced Director-Utilization and Denials Management to join our team. As a key member of our leadership team, you will be responsible for overseeing the utilization management process, ensuring compliance with regulatory requirements, and developing strategies to improve operational...


  • New York, New York, United States Village Care Full time

    Job Title: Director of Utilization ManagementAt VillageCare, we are seeking a highly skilled and experienced Director of Utilization Management to lead our team in driving operational efficiency and ensuring quality patient care.Job SummaryThe Director of Utilization Management will oversee the utilization review process, collaborate with interdisciplinary...

  • CDD Utility Manager

    2 weeks ago


    New York, New York, United States K2 Integrity Holdings Full time

    Job Title: CDD Utility ManagerAt K2 Integrity Holdings, we are seeking a highly skilled CDD Utility Manager to lead our team in designing, developing, and implementing a cutting-edge CDD utility to support our cross-border payment review program.Key Responsibilities:Oversee the design, development, and ongoing implementation of the CDD utility, ensuring...

  • CDD Utility Manager

    4 weeks ago


    New York, New York, United States K2 Integrity Full time

    Job Title: CDD Utility ManagerAt K2 Integrity, we are seeking a highly skilled CDD Utility Manager to lead our team in designing, developing, and implementing a cutting-edge CDD utility to support our cross-border payment review program.Key Responsibilities:Oversee the development and implementation of a CDD utility that ensures compliance with all...

  • CDD Utility Manager

    3 weeks ago


    New York, New York, United States K2 Integrity Full time

    Job OverviewK2 Integrity is seeking a highly skilled CDD Utility Manager to lead the design, development, and implementation of a cutting-edge CDD utility. This role will involve collaborating with cross-functional teams to create a sophisticated CDD application that can ingest third-party data, adapt to various customer types, and ensure compliance with...

  • CDD Utility Manager

    3 weeks ago


    New York, New York, United States K2 Integrity Full time

    Job Title: CDD Utility ManagerThe Financial Crimes Customer Due Diligence Utility Manager will lead a team of professionals responsible for designing, developing, implementing, and overseeing a CDD utility to support a groundbreaking cross-border payment review program.This hybrid role will involve leading cross-functional teams to develop a flexible and...

  • Utilization Manager

    2 days ago


    New York, New York, United States LESC Full time

    Job SummaryDescription:Key Responsibilities:Collaborate with the agency's mission to ensure high-quality care delivery to individuals served by assisting CASAC Counselors and supervisory staff with compliance requirements.Develop and maintain effective communication with external case managers, managed care organizations, and third-party payers to ensure...


  • New York, New York, United States WellSpan Health Full time

    Job SummaryWe are seeking a highly experienced and skilled Director of Utilization and Denials Management to join our team at WellSpan Health. As a key member of our leadership team, you will be responsible for overseeing the operations of the utilization management department and working closely with hospital, regional, medical group, Population Health,...

  • Registered Nurse

    3 weeks ago


    New York, New York, United States ChristianaCare Full time

    Job Title: Registered Nurse - Utilization ManagementChristianaCare is seeking a Registered Nurse (RN) for our Utilization Management team. As a Utilization Management Nurse, you will work with ED providers to review medical necessity and collaborate for discharge planning.Responsibilities:Performs admission and concurrent review to identify medical...