Executive Leader, Utilization Management & Clinical Ops

Posted yesterday

emblemhealthNew York (NY)

Medical and Health Services Managers All Other Miscellaneous Ambulatory Health Care Services

SENIORITY

Manager

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About the role

EmblemHealth seeks a senior clinical operations leader to redesign and oversee Utilization Management across Medicaid, Commercial, and Medicare. You will lead a large UM team and external vendors, shaping strategy to improve access to medically necessary care and strengthen provider and member experience. Responsibilities include driving enterprise UM transformation, vendor oversight, regulatory compliance, and data-driven performance improvements to align with quality and affordability goals.

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.