Utilization Management Program Lead
Greater NYC Area
As the Utilization Management Program leader, you’ll build Cityblock Health’s utilization management function and lead us through the regulatory certification process. You will work cross-functionally with our product and clinical areas to build out policies, processes and supporting technology capabilities that will support implementation of a fully delegated utilization management program. You will define the staffing needs of the function and work with operations and talent acquisition associates to hire and train the team needed to launch the program. You will also manage the life-cycle of the health plan delegation process from the pre-delegation assessment to on-going management and reviews/audits. As we scale to new markets and partner with more health plans, you will lead policy development, reporting, and quality improvement strategies that ensure Cityblock remains compliant with state, federal and NCQA regulations. You’ll work cross-functionally across our Clinical, Operations, Data and Product teams to optimize the utilization management program. You will be the primary point of contact for our partner UM Delegation Oversight Committees, ensuring all SLA requirements are met, corrective action plans are completed, and new requirements are implemented within our UM procedures.