Program Director (Utilization Management) Licensed Mount Sinai Health Partners

The Program Director (Licensed) is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and value-based care populations. This role drives cost-effective high-quality post-acute care through strategic partnerships data-driven performance oversight clinical and operational leadership and strong collaboration with internal and external stakeholders across the care continuum. The role requires a proactive leader with strong clinical insight analytical capabilities and change management expertise who can operate effectively in a fast-paced environment. This position reports to the VP of Care Transitions of Mount Sinai Health System.

Program Leadership & Expansion
Lead expand and sustain the SNF Utilization Management Initiative across a network; SNF partners.
Support post-acute clinical coordinators by escalating to SNF leadership to expedite patient discharge when clinically appropriate and safe.
Ensure continuity of program operations during staffing changes through cross-training and workflow optimization.
Performance Oversight & Analytics
Monitor ACO and value-based contract performance using Tableau dashboards CarePort Insight and internal reporting tools.
Develop refine and implement performance improvement strategies to ensure SNFs meet or exceed target benchmarks.
Deliver comprehensive monthly performance reports to executive leadership including the VP of Care Transitions and CMO.
Track and report on key performance indicators (KPIs) including utilization length of stay discharge disposition and preferred provider use.

Utilization & Cost Management
Oversee utilization management strategies to ensure appropriate levels of care at discharge.
Maintain reduced Certified Home Health Agency (CHHA) utilization rates matching or exceeding organizational benchmarks.
Collaborate with payers and SNF leadership to ensure appropriate authorization processes and optimized lengths of stay for short-term skilled services.

Clinical & Operational Oversight
Provide clinical oversight to Transitional Care Coordinators to ensure appropriate discharge planning and higher rates of home discharge.
Support and optimize workflows documentation and reporting within Epic.
Ensure staff adherence to standardized workflows clinical appropriateness and regulatory requirements.
Provider Vendor & Payer Relationship Management
Maintain and strengthen partnerships with skilled nursing facilities part B vendors CHHAs long-term home care agencies and hospice providers.
Lead Joint Operating Committee (JOC) meetings and provide ongoing performance updates and ad-hoc consultations.
Sustain strong payer relationships to support utilization management goals.

Preferred Provider Strategy
Monitor and report on ACO discharges to preferred vs. non-preferred SNFs.
Share performance feedback with hospital leadership to reinforce preferred provider utilization.
Lead in-person and virtual education sessions for social workers case managers and interdisciplinary inpatient teams.
Develop and maintain orientation and educational materials focused on:
oDischarge to home
oPreferred provider utilization
oAvailable transitional care resources (e.g. TOCC/NCC)

Change Management & Process Improvement
Lead rapid operational restructuring in response to staffing or organizational changes.
Develop and maintain training materials tip sheets disclaimers and Epic-integrated resources.
Partner with Communications to ensure initiatives are accurately represented internally and externally.
Evaluate workflows and processes continuously to improve efficiency productivity and outcomes.

Team Leadership & Development
Foster a culture of openness trust inclusivity and accountability.
Lead monthly team meetings and individual check-ins to align goals and co-create performance strategies.
Train retrain and onboard staff to new workflows ensuring operational stability during transitions (e.g. leaves of absence).
Provide constructive feedback coaching and hands-on support to drive high performance and engagement.
Support staff cross-training to ensure adequate coverage and continuity of care.

Perform other responsibilities as assigned

Education Requirements

• Masters or greater in Nursing Bachelors or greater in Physical Therapy or Occupational Therapy

Experience Requirements

• 7 plus years of experience in care management utilization management population health or value-based care.
• Demonstrated experience working with ACOs SNFs and post-acute care networks.

Licensing & Certification Requirements

• Current NYS licensure (Nursing Physical Therapy Occupational Therapy or related profession)

Additional Skills & Competencies

• Demonstrated interpersonal and leadership and organizational skills.
• Analytic ability to collect and organize information identifies problems and trends and formulate and implement corrective plans and programs.
• Ability to develop coordinate prioritize and allocate resources.
• Proven ability to lead complex initiatives with limited resources.
• Excellent communication relationship-building and presentation skills.
• Advanced MS Office Suite Skills
  

Non-Bargaining Unit E01 - Partner MSO Services - MSH Mount Sinai Hospital