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About the Role
The Manager of Clinical Business Operations ensures Utilization Management non-clinical operations meet CMS and NYSDOH requirements while supporting departmental quality assurance and business objectives. This role guides non-clinical staff performance, translates regulatory expectations into workable processes, and helps drive consistent, audit-ready outcomes.
Responsibilities
- Monitor non-clinical productivity and deliverables
- Support utilization management projects and departmental initiatives tied to regulatory alignment
- Develop and update policies
- Communicate operational impacts to upstream and downstream stakeholders
- Provide administrative subject matter expertise
- Contribute to corrective action plans
- Identify operational risks and partner on mitigation plans
- Support additional initiatives as directed
- Review dashboards and recent outputs to confirm non-clinical work is tracking to expected standards
- Connect with team members to remove blockers and reinforce consistent documentation practices
- Interpret new or updated CMS/NYSDOH guidance
- Translate guidance into clear internal messaging
- Align timelines with partners who depend on UM operational outputs
- Join working sessions to calibrate monitoring approaches
- Draft or refine policy language
- Prepare concise summaries that clarify downstream impacts
- Coach and develop staff through targeted feedback and short learning touchpoints
- Consolidate observations into practical recommendations for leadership
- Ensure issues are surfaced early and next steps are well-defined
Requirements
- 3+ years in Utilization Management/Managed Care with Medicare/Medicaid UM quality monitoring and regulatory processes (non-clinical)
- Strong leadership, communication, and stakeholder-management skills
- Ability to analyze data, measure outcomes, and escalate action plans
- Comfort working quickly, prioritizing effectively, and meeting deadlines
- Strong computer/software proficiency
Skills
- Leadership
- Communication
- Stakeholder management
- Data analysis
- Outcome measurement
- Action plan escalation
- Prioritization
- Deadline management
- Computer proficiency
- Software proficiency
Location
- Hybrid (Must Reside in NY/NJ/CT)
Work Type
- Hybrid
- Full-time
Experience Level
- Manager
Education Level
- Bachelor's degree preferred
Salary/Compensations
- $118,135.58 - $132,902.53
About the Company
- VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.
- Our mission is to promote healing, better health and well-being to the fullest extent possible.
- Our care is offered through a comprehensive array of community and residential programs, as well as managed care.
- VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.