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🥝 Utilization Management Director
Catholic Health | Melville, United States | Posted June 19, 2026
Job Description
DUTIES
Develop, implement and maintain policies and procedures for all UM functions.Coordinate efforts between CHS and Facilities Care Management/Coordination Departments to develop efficient workflows and processes.Oversee and manage daily UM Department functions and staff.Develop collaborative Payer relationships to enhance communication and reconciliation processes.Serve as a resource to Care Coordination and other departments for Revenue Cycle and Managed Care issues.Identify payer trends that adversely affect utilization and reimbursement cycle.Track key metrics with monthly reporting to LeadershipWith Physician Advisors identify and implement educational opportunities for clinical and medical staffPrepare utilization reviews for submission to payors, as neededSupport Director of Appeals, as needed.Provides support for ongoing projects as requiredAttends meet...