Top 4762 Manager Utilization Management Jobs

Senior Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $125,400 - $156,700 a year
- Full-time
- Nursing
- 6 years
- RN License
Utilization Management Manager REMOTE
Kindred Hospitals Dallas/Ft Worth District —Louisville, KY
- Remote
- Nursing
- Microsoft Outlook
- English
2d
Radiologic Technologist/ Materials Manager
Careplex Orthopaedic Ambulatory Surgery Center —Hampton, VA
- $28 - $38 an hour
- Full-time
- Writing skills
- BLS Certification
- Mid-level
- Health savings account
- Health insurance
Quick Apply
8d
Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
- Full-time
- Nursing
- Psychiatry
- RN License
Assistant Nurse Manager - NICU - Hopewell - Full Time - DAYS
Capital Health —Pennington, NJ
- $47.68 - $63.56 an hour
- 8 hour shift
- Nursing
- Surgery
- RN License
- AD&D insurance
- Disability insurance
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
Quick Apply
Histology Manager
Medipath, LLC —Miramar, FL
- From $120,000 a year
- Full-time
- Spanish
- Word processing
- English
- Health savings account
- Relocation assistance
Quick Apply
Registered Nurse- Integrated Care Manager PRN (Pontiac)
McLaren Oakland —Pontiac, MI
- From $35.84 an hour
- Weekends as needed
- Nursing
- RN License
- Hospital
- Free parking
- Health savings account
Quick Apply
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Registered Nurse Manager - Surgery Center
South Bend Clinic —South Bend, IN
- Full-time
- CPR Certification
- Nursing
- RN License
- Disability insurance
- Health insurance
Quick Apply
1d
Clinical Nurse Manager Telemetry – Acute Care Setting
Mountain View Regional —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
CASE MANAGER -MH ADULT
Southside Behavioral Health —South Boston, VA
- $44,435 - $77,761 a year
- 8 hour shift
- Bilingual
- Background check
- Clean driving record
- Health insurance
- Dental insurance
Quick Apply
RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Free parking
- Paid holidays
Quick Apply
Clinical Supervisor
Murtis Taylor Human Services System —Cleveland, OH
- $58,000 - $65,000 a year
- Weekends as needed
- LMFT
- Nursing
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Clinical Site Manager, Physical Therapist
Family Health Centers of San Diego —El Cajon, CA
- $90,000 - $154,885 a year
- Full-time
- CPR Certification
- Clean driving record
- BLS Certification
- Paid holidays
- Health insurance
Quick Apply
10d
Rehab Manager-OT/PT
INNOVATIVE INTEGRATED HEALTH —Bakersfield, CA
- $130,000 - $140,000 a year
- Full-time
- CPR Certification
- Microsoft Outlook
- Writing skills
- Health savings account
- Health insurance
Home Health Care RN Case Manager
ACE Home Health Care —Howard City, MI
- $65 - $80 a year
- Full-time
- Vital signs
- RN License
- HIPAA
- Continuing education credits
- Mileage reimbursement
Quick Apply
RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
Quick Apply
Case Manager - Bronson Battle Creek
Bronson Healthcare —Battle Creek, MI
- Part-time
- Acute care
- Nursing
- RN License
Quick Apply
Lead Clinical Analyst
Health Network One —Miami, FL
- 3 years
- Bachelor's degree
- Mentoring
Quick Apply

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Senior Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

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Job Details

Full-time
$125,400 - $156,700 a year

Qualifications

Health insurance authorizations
Appeals
Utilization review
RN License
Managed care organization experience
Regulatory compliance
Clinical case management
Utilization management
Desktop applications
Resource utilization in healthcare
Medical insurance appeals management
Managing projects
Productivity software
Insurance claims appeal handling
Senior leadership

Full Job Description

Requisition #:

7475

# of openings:

Employment Type:

Full time

Position Status:

Permanent

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Effectively manage the daily operations, workflow, and supervise clinical and non-clinical staff to provide support for the utilization management, benefits and service coordination and appeal process).
Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes.
Access and analyze all processes on an ongoing basis to determine their effectiveness, eliminate inefficiencies, and make recommendations to senior management to improve workflow, operations, and staff performance.
Coordinate activities between clinical programs, communication, and report requirements to maintain operational efficiencies and to be in compliance with the Department of Labor (DOL), Summary Plan Description (SPD) departmental protocols and clinical policies and procedures.
Interact and collaborate with other departments in troubleshooting, problem solving, and exchanging information in conjunction with maintaining effective communication with providers and members.
Participate in interdepartmental committees/meetings.
Lead internal audits for designated unit
Develop and maintain ongoing quality insurance process
Responsible for staff development, clinical orientation, ongoing education, and training programs to meet the changing needs of the Department.
Continually assess clinical staff performance against internal and external departmental and industry standards.
Perform additional duties and projects as assigned by managed

Qualifications

Bachelor’s Degree in Nursing, Business or Health Care Administration or equivalent years of work experience required; plus
Current New York State of Registered Nurse (RN) license required
Minimum six (6) years work experience in Utilization/Case Management/Appeals Programs within a managed care organization, to include a minimum of three (3) years progressive leadership and management experience
Experience working with Milliman guidelines or other regulatory protocols, claims processing, medical coding and interpreting provider contracts
Ability to make critical business clinical decisions independently.
Ability to work with automated Prior Authorization system
Intermediate level of Microsoft Office suite applications
Strong critical thinking and analytical skills with effective troubleshooting and problem-solving abilities
Excellent time management and project management skills
Effective verbal and written communication skills
Ability to prioritize and be detail-oriented, multi-task and must strive in fast-paced environment

Apply Now

Refine Your Search

Manager Utilization Management jobs

Senior Manager, Utilization Management

Utilization Management Manager REMOTE

Radiologic Technologist/ Materials Manager

Nurse Manager Psychiatric Services

Assistant Nurse Manager - NICU - Hopewell - Full Time - DAYS

Patient Care Manager - Floater (RN)

Histology Manager

Registered Nurse- Integrated Care Manager PRN (Pontiac)

HOME CARE - RN CASE MANAGER

Registered Nurse Manager - Surgery Center

Clinical Nurse Manager Telemetry – Acute Care Setting

CASE MANAGER -MH ADULT

RN Unit Manager

Clinical Supervisor

Clinical Site Manager, Physical Therapist

Rehab Manager-OT/PT

Home Health Care RN Case Manager

RN Clinical Manager

Case Manager - Bronson Battle Creek

Lead Clinical Analyst

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