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This position is the clinical lead for all departmental integrations and payer clinical guideline review for staff instruction and clinical staff best practice advisories. Track and communicate all payer notifications, including denial notifications (pre and post service) with analysis and summary for organizational impact. Contact payers to provide clinical information upon request. Perform Peer to Peer reviews on pre-service denials. Analysis and problem solving skills to understand, track and present process improvement initiatives to leadership and staff. Act as a resource for all medical terminology questions for PSU staff and management. Develop and assist training team with any training tools for staff development on new processes. Review the quality and integrity of work by analyzing random audits, and providing trend analysis. Work collaboratively with all departments including contracting for any payer escalations and/or issues. Assisting management team in addressing productivity, QA errors, and in-servicing of associates. Assisting management team for hiring, progressive discipline and terminating of employees. Works with department Directors and Managers to ensure compliance with departmental policies, regulatory requirement, budget, and Human Resources.



Bachelor's Degree. 

NY State Licensed/Registered PA or RN.  Five years experience.

Experience with Utilization Management/Authorizations

Knowledge of medical terminology Excellent Leadership Skills

Detail-oriented and organized Analytical and problem-solving skills

Exceptional interpersonal abilities, including strong written and verbal communication skills Proven ability to manage multiple projects simultaneously while achieving positive outcomes



Department: Health Service Receivables Bargaining Unit: Non Union Campus: YONKERS  Employment Status: Regular Full-Time Address: 3 Executive Boulevard, Yonkers
Shift: Day Scheduled Hours: 9 AM-5:30 PM Req ID: 202461 



Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.


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. 



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

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

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