Director- Managed Care UM Coordinator (Director of Fiscal Affairs), Managed Care Administration
About NYC Health
Hospitals Empower Every New Yorker -- Without Exception -- to Live the Healthiest Life Possible NYC Health
Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. Job Description SUMMARY OF DUTIES AND
Responsibilities:
The Director- Managed Care UM Coordinator will act as a liaison of the Managed Care department for utilization management functions across the NYC Health
Hospitals hospital, ambulatory care, and post-acute care system. The Director will help maximize system revenue by ensuring broad understanding, effective implementation and rigorous enforcement of the system's contractual and regulatory rights. General tasks and responsibilities will include:
A deep study and understanding of all NYC H+H managed care contracts and payment rules in order to identify and implement ways to appropriately maximize reimbursement opportunities for services rendered across care settings; As a member of the Utilization Management Council, provide a Managed Care lens to advise and help implement systemwide policies and protocols to enhance the following workstreams:
payer notification/preauthorization, concurrent review, extended stay documentation, discharge planning, and the clinical appeal process; Support physician advisors at each inpatient facility to help establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions based on contracted payers' policies. Effectively liaise with contracted payers to facilitate required communication between the payer and the inpatient facility. Ensure these methods are being implemented in a standard way throughout the system. Collaborate with department leadership to advocate for contractual protections and settlement opportunities based on knowledge of system's utilization management challenges. Routinely meet with facility-based and system level revenue cycle colleagues to educate and update on utilization management projects, managed care updates, clinical appeal payment trends, discharge planning etc.; Collaborate with the appeal vendor process and assist in resolving issues as needed; Perform other job related duties as required Minimum Qualifications 1. Master's degree with a major in accounting, finance or business administration with emphasis on accounting and financial systems from an accredited college or university; and four (4) years of responsible level experience in fiscal management or administration with an emphasis in financial systems, management information and controls, of which at least three (3) years shall have been in responsible administrative or managerial capacity; or 2. Baccalaureate degree with a major in related fields, as indicated in (1) above, from an accredited college or university; and five (5) years of experience as indicated in (1), of which at least three (3) years shall have been in a responsible administrative or managerial capacity; and 3. Knowledge of total accounting and financial management both in systems theory and practice; or 4. A satisfactory equivalent of education, training and experience. However, all candidates Department Preferences EDUCATIONAL LEVEL:
A Master's Degree from an accredited college or university in Business, or Public Administration. KNOWLEDGEABLE IN:
Must be able to read and comprehend large documents Must have knowledge of medical terminology PREFERRED SKILLS:
Excellent communication and people skills required. Work experience in utilization management, denials management, or managed care operations in health care facility or insurance industry.
Salary Range:
$80K -- $120K
Minimum Qualification
Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
Hospitals Empower Every New Yorker -- Without Exception -- to Live the Healthiest Life Possible NYC Health
Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. Job Description SUMMARY OF DUTIES AND
Responsibilities:
The Director- Managed Care UM Coordinator will act as a liaison of the Managed Care department for utilization management functions across the NYC Health
Hospitals hospital, ambulatory care, and post-acute care system. The Director will help maximize system revenue by ensuring broad understanding, effective implementation and rigorous enforcement of the system's contractual and regulatory rights. General tasks and responsibilities will include:
A deep study and understanding of all NYC H+H managed care contracts and payment rules in order to identify and implement ways to appropriately maximize reimbursement opportunities for services rendered across care settings; As a member of the Utilization Management Council, provide a Managed Care lens to advise and help implement systemwide policies and protocols to enhance the following workstreams:
payer notification/preauthorization, concurrent review, extended stay documentation, discharge planning, and the clinical appeal process; Support physician advisors at each inpatient facility to help establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions based on contracted payers' policies. Effectively liaise with contracted payers to facilitate required communication between the payer and the inpatient facility. Ensure these methods are being implemented in a standard way throughout the system. Collaborate with department leadership to advocate for contractual protections and settlement opportunities based on knowledge of system's utilization management challenges. Routinely meet with facility-based and system level revenue cycle colleagues to educate and update on utilization management projects, managed care updates, clinical appeal payment trends, discharge planning etc.; Collaborate with the appeal vendor process and assist in resolving issues as needed; Perform other job related duties as required Minimum Qualifications 1. Master's degree with a major in accounting, finance or business administration with emphasis on accounting and financial systems from an accredited college or university; and four (4) years of responsible level experience in fiscal management or administration with an emphasis in financial systems, management information and controls, of which at least three (3) years shall have been in responsible administrative or managerial capacity; or 2. Baccalaureate degree with a major in related fields, as indicated in (1) above, from an accredited college or university; and five (5) years of experience as indicated in (1), of which at least three (3) years shall have been in a responsible administrative or managerial capacity; and 3. Knowledge of total accounting and financial management both in systems theory and practice; or 4. A satisfactory equivalent of education, training and experience. However, all candidates Department Preferences EDUCATIONAL LEVEL:
A Master's Degree from an accredited college or university in Business, or Public Administration. KNOWLEDGEABLE IN:
Must be able to read and comprehend large documents Must have knowledge of medical terminology PREFERRED SKILLS:
Excellent communication and people skills required. Work experience in utilization management, denials management, or managed care operations in health care facility or insurance industry.
Salary Range:
$80K -- $120K
Minimum Qualification
Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
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