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Vice President Supervisor Utilization Management Jobs

Med-Metrix

Vice President, Case Management

Brooklyn, NY · On-site

$210K - $225K/yr

The Vice President, Case Management is responsible for strategic planning and the advancement of case management, to include utilization management, coordination of care and transition management.

HealthAxis

Senior Vice President of Sales

The SVP of Sales will lead and scale a high-performance sales organization focused on complex ... utilization management, interoperability, analytics, and related partner solutions. The role ...

Mosaic Health, LLC.

NY · On-site

$220 - $320/hr

The VP will work closely with primary care providers, care management, palliative care, hospice ... utilization.The VP will hold full accountability for the budgeting, operations, growth, quality ...

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Vice President Supervisor Utilization Management information

What is the difference between Vice President Supervisor Utilization Management vs Utilization Management Supervisor?

AspectVice President Supervisor Utilization ManagementUtilization Management Supervisor
CredentialsTypically requires advanced degrees (e.g., Master's, RN, or related certifications), leadership experience, and industry-specific licensesUsually requires a bachelor's degree, relevant certifications (e.g., CCM, RHIA), and some management experience
Work EnvironmentExecutive-level setting, overseeing multiple teams or departments, strategic planningOperational setting, managing daily utilization review activities, team supervision
Employer & Industry UsageUsed in healthcare organizations, insurance companies, and managed care firms at senior levelsCommonly found in healthcare providers, insurance companies, and health plans at supervisory levels

The Vice President Supervisor Utilization Management holds a senior leadership role with strategic responsibilities, while the Utilization Management Supervisor focuses on daily operations and team management. Both roles require industry-specific knowledge, but the VP position involves broader oversight and decision-making at an organizational level.

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Vice President Supervisor Utilization Management jobs near you
Infographic showing various Vice President Supervisor Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution.

Vice President of Medical Directors - Health Plan Experience

MetroPlusHealth

Manhattan, NY • On-site

$360K - $380K/yr

Full-time

Posted 26 days ago

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

272nd of 311 rated insurance

Job description

Position Overview:
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that
Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come
to work being proud of what you do every day.
Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical quality,
utilization, and assuring appropriate health care delivery, the Vice President of Medical Directors serves in a policy,
operational and strategic capacity. The Vice President of Medical Directors' overall purpose is to work across
medical management functions, with a focus on Utilization Management and Business Intelligence, and across all
lines of business and pharmacy. This is a broad function that includes day-to-day operations, data and reporting
design, high-level strategy, planning, and policy involvement.
Scope of Role & Responsibilities:
  • Reviews cases, determines medical necessity, and consults with physicians to review length of stay and reimbursement documentation.
  • Supports Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria.
  • Works with the VP of Clinical Services, who oversees day-to-day UM operations.
  • Provides clinical support for members and provider appeals.
  • Build a health informatics function and ensures decisions are made according to data insights.
  • Assists in new technology assessment and clinical policy review as required.
  • Responsible for implementation of ongoing changes in policy and procedures from state and government entities.
  • Participate in the development of strategic planning for existing and expanding business.
  • Represents the health plan at regulatory meetings held by the New York State Department of Health, the
  • New York City Department of Health and Mental Hygiene, and managed care trade organizational meetings as necessary.
  • The VP of Medical Directors will be required to come to MetroPlusHealth HQ once a week (preferably on Thursdays)
  • Performs other duties as needed and assigned by the Chief Medical Officer

Required Education, Training & Professional Experience:
  • Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
  • A minimum of three years' clinical experience post-residency
  • A minimum of five years' experience in a managed care setting with at least 3 years specifically overseeing Utilization Management.
  • Proven experience with heath informatics/data sciences and regulatory compliance
  • Experience with NYS regulations and compliance is strongly preferred

Licensure and/or Certification Required:
  • Valid New York State license and current registration to practice medicine in the state of New York.
  • Board Certification

Professional Competencies:
  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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