St. John's Riverside Hospital · 23 hours ago
Senior Director of Managed Care/ Denials
Yonkers, NY
Full-time
Onsite
Lead/Staff, Director/Executive
5+ years expSt. John's Riverside Hospital is seeking a Senior Director of Managed Care and Denials to oversee all aspects of managed care. This senior leadership role involves enhancing patient throughput, managing reimbursement processes, and ensuring compliance with regulatory standards.
Health CareHospitalMedicalNon ProfitOncologyPrimary and Urgent Care
Hiring Manager
Anne Tinsley, SHRM-CP
Responsibilities
Oversees discharge planning and utilization review of cases throughout the hospital system. BHS compliance with current OASAS and TJC standards
Directs development of specific short- and long -range programs and projects plans to achieve the facility’s goals and objectives
Establishes department policies and procedures
Establishes best practices for department and staff
Responsible for overseeing patient Length of Stay. Prepares monthly statistics and manages department database
Ensures staff is trained and using Milliman and LOCADTRs
Coordinates the Utilization Review process and participates in related interdisciplinary committees and working groups
Coordinates the review and response process for denials
Implements process to avoid hospital denials
Responsible for the planning and coordination of department activities, the operational efficiency and effectiveness of the department
Responsible for hiring, firing, discipline and performs performance appraisals for all Case Management
Responsible for ensuring the department meets and adheres to all applicable federal, state, JCAHO, OASAS, and local regulatory agency requirements
Participates on various committees and other task forces as may be established by management to plan, organize and drive the facility
Prepares the performance improvement reports quarterly for presentation at Performance Improvement committee meeting
Confers with other department directors when necessary to resolve procedural difficulties, clarifying department responsibilities, objectives and resolving identified problems
Makes recommendations on insurance company contract initiation, renewals, and termination
Weekly communication with Associate VP of Nursing pertaining to implementation strategies for the achievement of strategic vision and annual goals
Responsible for preparation and overall management of the annual budget for the departments
Qualification
Required
RN license in NY
BSN
Minimum 3 – 5 years of acute care leadership experience, with at least 2 years as a Director of Case Management
Minimum of 2 years current Behavioral Health Experience and a minimum of 5 years of progressive leadership experience in case management and utilization review
Regulatory expertise: In-depth knowledge of federal, state, and industry regulations governing managed care and reimbursement and OASAS regulations
Preferred
Master of Science in Nursing (MSN), Master of Healthcare Administration (MHA), or Master of Business Administration (MBA) with a focus of healthcare
Certification in Case Management (CCM), Nurse Executive (NE-BC), or Director of Nursing Services (DNS-CT)
Company
St. John's Riverside Hospital
St. John's Riverside Hospital offers primary care, women's health, cancer care, cardiology, rehabilitation and behavioral health services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Herta Muller
Chief Nursing Officer
Paul Antonecchia, MD, MBA
Chief Medical Officer
Recent News
HealthCareIT News
2025-10-23
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