Top 4701 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
Supervisor of Utilization Management
Partnership HealthPlan of California —Fairfield, CA
- $141,067.17 - $183,387.32 a year
- Full-time
- Nursing
- RN License
- Customer service
Utilization Management Manager
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Manager, Utilization Management
AdventHealth Corporate —Altamonte Springs, FL
- $79,402.93 - $147,697.47 a year
- Full-time
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
11d
Manager, Utilization Management
GLOBALHEALTH HOLDINGS LLC —Oklahoma City, OK
- Full-time
- RN License
- HIPAA
- Mid-level
- Health insurance
Quick Apply
12d
RN Manager of Utilization Management
North Memorial Healthcare —Robbinsdale, MN
- $52.46 - $81.30 an hour
- 8 hour shift
- Hybrid work
- Nursing
- RN License
- Bachelor's degree
- Health insurance
- Tuition reimbursement
Manager- Utilization Management
ECU Health —Greenville, NC
- $92,206.40 - $134,397.12 a year
- Nursing
- Mid-level
- Master's degree
Regional Manager Utilization Management
Cleveland Clinic —Cleveland, OH
- $76,540.00 - $116,747.50 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Dental insurance
- Vision insurance
14d
Manager, Utilization Management Nurse Management
Blue Shield of California —El Dorado Hills, CA
- $111,540 - $167,420 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Work from home
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
Utilization Management Manager
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- Nursing
- RN License
Care Manager - Utilization Management (Must Have UAS Experience)
MetroPlus Health Plan —New York, NY
- $112,351 a year
- Full-time
- Remote
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
Manager Utilization Management
Children's of Alabama —Birmingham, AL
- Full-time
- Nursing
- RN License
- Bachelor of Science
Mgr Denials Management
Brown University Health —Providence, RI
- $97,718.40 - $195,436.80 a year
- 8 hour shift
- Remote
- RN License
- 5 years
- Writing skills
Regional Clinical Manager
VITRA Health —Boston, MA
- $130,000 - $140,000 a year
- Full-time
- Nursing
- RN License
- Customer service
- Disability insurance
- Health insurance
Quick Apply
Respiratory Therapy Manager
Froedtert South, Inc. —Pleasant Prairie, WI
- Full-time
- Acute care
- PALS Certification
- Hospital
- Opportunities for advancement
Quick Apply
7d
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Histology Manager
Medipath, LLC —Miramar, FL
- From $120,000 a year
- Full-time
- Spanish
- Word processing
- English
- Health savings account
- Relocation assistance
Quick Apply
Nurse Program Case Manager
Adult Community Educational Services, Inc (ACES) —Wauchula, FL
- $60,000 - $80,000 a year
- Full-time
- Background check
- Nursing
- Medication administration
- Health insurance
- Dental insurance
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

Supervisor of Utilization Management

Utilization Management Manager

Care Manager, Concurrent Review (Remote)

Manager, Utilization Management

Manager, Utilization Management

RN Manager of Utilization Management

Manager- Utilization Management

Regional Manager Utilization Management

Manager, Utilization Management Nurse Management

CHS Utilization and Appeals Manager

Utilization Management Manager

Care Manager - Utilization Management (Must Have UAS Experience)

Manager Utilization Management

Mgr Denials Management

Regional Clinical Manager

Respiratory Therapy Manager

HOME CARE - RN CASE MANAGER

Histology Manager

Nurse Program Case Manager

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