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Clinical Team Lead

2 months ago

New York, New York, United States NYC Health Hospitals Full time
Job Title: UM Clinical Team Lead

At NYC Health + Hospitals, we are committed to providing high-quality healthcare services to our community. We are seeking a highly skilled and experienced UM Clinical Team Lead to join our team.

Job Summary

The UM Clinical Team Lead will provide oversight of the administration of departmental utilization management activities, ensuring that cases are reviewed timely and meeting NYS DOH and CMS regulatory standards. This role will also support care management team development through direct staff training and development activities.

Key Responsibilities
  • Supervise staff conduct utilization review
  • Oversee utilization review activities and ensure cases are reviewed timely
  • 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
Requirements
  • 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
What We Offer

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply.