Cayuga Medical Center
  • Clinical Resource Management
  • Ithaca, NY, USA
  • Full Time
  • Administrative Support / Clerical

Essential Functions:

  • Aligns the activities of the Utilization Management division with the overall mission objectives, organizational values and strategic imperatives of the Cayuga Health System and Cayuga Health Partners Network.
  • Provides overall strategic direction and oversight of the dayto-day operations of utilization programs to meet hospital, System and Network utilization goals while maintaining high quality of care and outstanding customer satisfaction.
  • Acts as a resource to physicians and advanced practice providers, nursing, and operational leaders across the System and Network to ensure compliance with government and contractual guidelines
  • Directs and develops specialty programs to support and ensure success of the UM program, inclusive of innovative programs that emphasize and utilize collaborative work relationships, and internal and external partnerships.
  • Collaborates with finance and revenue cycle to identify opportunities and gaps, develop improvement strategies, and monitor results
  • Reevaluates the UM program annually and ensures the success of UM functions through medical review and prior authorization, behavioral health management, and inpatient and outpatient review. 
  • Analyzes and reports significant utilization trends, patterns, and impact to appropriate System and Network committees to improve value and care delivery.
  • Serves as the contract liaison for the System and the Network on issues pertaining to new or existing contracts with outside vendors to support the needs of our patients.
  • Develops, monitors and reports program operating budgets including forecasting spending levels, staffing requirements and resource needs
  • Assures compliance with Federal, State, TJC, other regulatory agencies and internal standards and requirements.
  • Hires, coaches, trains and performance manages staff to ensure results.
  • Facilitates implementation of best practices and training for the System and Network on issues related to utilization management.

Qualifications:

  • Minimum of ten years of nursing experience required.
  • Minimum of five years in an acute care setting and/or managed care environment performing case management or utilization management.
  • BSN or bachelor's degree in health care related field such as management, health services administration.
  • Current registered nurse license in the state of NY
  • Current Certified Professional in Utilization Management

 

Preferred Qualifications:

 

Master's degree in a related field such as nursing, business or health services administration preferred

 

Certified Case Manager or other applicable certifications preferred

 

Additional Requirements:

  • Demonstrated knowledge of operations and healthcare management; TJC, Medicare, Medicaid and other local, state and federal regulations.
  • Requires deep understanding of health care and managed care delivery systems
  • Ability to work strategically while also working operationally and managing a team
  • Strong critical thinking, problem solving and analytical skill
  • Demonstrated interpersonal, negotiation, and leadership skills
  • Effective oral and written communication skills to help influence change and transformation
Cayuga Medical Center
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