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:
o Discharge to home
o Preferred provider utilization
o Available 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

• Master?s or greater in Nursing, Bachelor?s 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

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $132400.32 - $209622 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.