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CLINICAL MANAGER CARE MANAGEMENT ORG

YONKERS, NY, US


The Clinical Manager has responsibility for the day to day operations of the Central Intake Unit.   The clinical manager  will manage/ oversee all day to day administrative and workflow processes associated with the Central intake unit involved in supporting the utilization management processes. The clinical manager is also responsible for overseeing all operational aspects associated with authorization communication to health plan members. The Clinical Manager supervises administrative, nursing and other professional staff and provides education to staff regarding regulatory and contractual changes related to health plans determinations for Medicare, Medicaid and Commercial plans. The clinical manager  participates in health plan audits, conducts staff meetings, complete performance appraisals and assists in program monitoring; identifies and assists in resolving barriers to successful implementation of the Utilization Management Program. The clinical manager position is critical to the operations of the Central Intake Unit and the overall Medical Management Utilization Management Department to maintain compliance with regulatory requirements including, but not limited to CMS, DOH, Health Plan contractual obligations and NCQA accreditation.

 

This position requires
• Bachelor degree in nursing or a health-related field (i.e. DPT, physician assistant, MSW). Masters degree preferred.
• Current active license/registration in New York State as applicable and additional state licenses/registration (NJ, CT, etc) as required by Program. 
• Medical Management experience in a managed health care setting preferred. 
• 5 years of clinical practice, preferably including at least 2 years in an outpatient setting .
• Minimum 2 years of supervisory experience. 
• Professional certification in Case Management, Utilization Management, or Quality Management preferred. 

 

Department: CMO Bargaining Unit: Non Union Campus: YONKERS  Employment Status: Regular Full-Time Address: 200 Corporate Boulevard S, Yonkers
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 153001 

 

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

 

N/A 


Mission:
To heal, to teach, to discover and to advance the health of the communities we serve.

Vision:
To be a premier academic medical center that transforms health and enriches lives.

Values
Define our philosophy of care, they shape our actions and motivate and inspire us to pursue excellence and achieve the goals we have set forth for the future. Our values include:

  • Humanity
  • Innovation
  • Teamwork
  • Diversity
  • Equity

 

 

 


Nearest Major Market: Yonkers
Nearest Secondary Market: New York City