Top 5752 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
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
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
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
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
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
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
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
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
Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
- Full-time
- Nursing
- Psychiatry
- RN License
Registered Nurse Case Manager
Confidential —Peabody, MA
- $90,000 - $100,000 a year
- Full-time
- Background check
- Nursing
- RN License
- Free parking
- Health savings account
Quick Apply
12d
Case Manager - Bronson Battle Creek
Bronson Healthcare —Battle Creek, MI
- Part-time
- Acute care
- Nursing
- RN License
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
Unit Manager
Potomac Falls & Rehab Center —Sterling, VA
- $87,000 - $105,000 a year
- Full-time
- Background check
- Patient monitoring
- RN License
- Continuing education credits
- Health savings account
Quick Apply
Care Manager - Registered Nurse
Crouse Hospital —Syracuse, NY
- $80,000 - $86,000 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental 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
UM Case Manager/Appeals Coordinator
Havenwyck Hospital (UHS) —Auburn Hills, MI
- $60,000 - $69,000 a year
- Full-time
- Background check
- LMFT
- Nursing
- Loan repayment program
- Health 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
Assistant Rehab Manager
Promise Care NJ —East Orange, NJ
- $100,000 - $112,000 a year
- Full-time
- Mid-level
- 3 years
- Driver's License
- Continuing education credits
- Health savings account
Quick Apply
Clinical Nurse Manager, Adolescent Psychiatry
Cincinnati Children's Hospital —Cincinnati, OH
- $100,526.40 - $130,686.40 a year
- Full-time
- Nursing
- Psychiatry
- Inpatient

I want to receive the latest job alert for Manager Utilization Management

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Manager Utilization Management jobs near

Senior Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

Apply Now

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

Manager, Utilization Management

Care Manager, Concurrent Review (Remote)

RN Manager of Utilization Management

HOME CARE - RN CASE MANAGER

Nurse Program Case Manager

Home Health Care RN Case Manager

Regional Clinical Manager

Nurse Manager Psychiatric Services

Registered Nurse Case Manager

Case Manager - Bronson Battle Creek

RN Unit Manager

Unit Manager

Care Manager - Registered Nurse

Respiratory Therapy Manager

UM Case Manager/Appeals Coordinator

Histology Manager

Assistant Rehab Manager

Clinical Nurse Manager, Adolescent Psychiatry

I want to receive the latest job alert for Manager Utilization Management

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected