Top 4716 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
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Care Manager - Utilization Management (Must Have UAS Experience)
MetroPlusHealth —New York, NY
- $112,351 a year
- Remote
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
Quick Apply
Sr. Manager of Member Engagement
Private Health Management —Remote
- $120,000 - $180,000 a year
- US work authorization
- Senior level
- Leadership
- Health insurance
- Dental insurance
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Utilization Management Manager Full Time
Kindred Hospitals Mountain District Office —Las Vegas, NV
- Full-time
- Nursing
- Microsoft Outlook
- Hospital
13d
Pharmacy Operations Manager (Remote)
MRIoA —Remote
- Full-time
- Remote
- Background check
- Pass drug screening
- Supervising experience
- Paid holidays
- Health insurance
Quick Apply
Clinical Manager, Global
Spring Health —Remote
- $97,325 - $114,500 a year
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- 3 years
- Health savings account
- Health insurance
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Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
5d
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
Histology Manager
Medipath, LLC —Miramar, FL
- From $120,000 a year
- Full-time
- Spanish
- Word processing
- English
- Health savings account
- Relocation assistance
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Radiologic Technologist/ Materials Manager
Careplex Orthopaedic Ambulatory Surgery Center —Hampton, VA
- $28 - $38 an hour
- Full-time
- Writing skills
- BLS Certification
- Mid-level
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- Health insurance
Quick Apply
10d
RN Care Manager Lead
Cone Health —Greensboro, NC
- Full-time
- Nursing
- RN License
- Hospital
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
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HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
- Full-time
- Nursing
- Psychiatry
- RN License
Supervising Pharmacist
Integrea Community Mental Health Systems —Opelika, AL
- Extended hours
- Bachelor of Science
- Residential
- Bachelor's degree
- Dental insurance
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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
Clinical Nurse Manager
Centennial Surgery Center —Voorhees, NJ
- $60 - $63 an hour
- Full-time
- Background check
- Nursing
- Surgery
- Health savings account
- Paid holidays
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Program Manager Trauma RN - Trauma Services
McLaren Greater Lansing —Lansing, MI
- $35.84 - $53.75 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
12d

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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

Care Manager - Utilization Management (Must Have UAS Experience)

Sr. Manager of Member Engagement

Utilization Management Manager Full Time

Pharmacy Operations Manager (Remote)

Clinical Manager, Global

Manager, Utilization Review

Utilization Management Manager

Care Manager, Concurrent Review (Remote)

Histology Manager

Radiologic Technologist/ Materials Manager

RN Care Manager Lead

RN Unit Manager

HOME CARE - RN CASE MANAGER

Nurse Manager Psychiatric Services

Supervising Pharmacist

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

Clinical Nurse Manager

Program Manager Trauma RN - Trauma Services

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