Top 5485 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
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RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Concord, CA
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Utilization Management Manager Full Time
Kindred Hospitals Mountain District Office —Las Vegas, NV
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Sr. Manager of Member Engagement
Private Health Management —Remote
- $120,000 - $180,000 a year
- US work authorization
- Senior level
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Clinical Manager, Global
Spring Health —Remote
- $97,325 - $114,500 a year
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- LMFT
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- 3 years
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Pharmacy Operations Manager (Remote)
MRIoA —Remote
- Full-time
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- Background check
- Pass drug screening
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Utilization Management Manager
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
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Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
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7d
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
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Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
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Froedtert South, Inc. —Pleasant Prairie, WI
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Nurse Manager | Medical Oncology & Medical Specialties
Concord Hospital —Concord, NH
- Full-time
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Pharmacy Manager
Weis Markets —Burnham, PA
- $94,000 - $155,000 a year
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RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
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Nurse Manager - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
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Supervising Pharmacist
Integrea Community Mental Health Systems —Opelika, AL
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Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
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Radiologic Technologist/ Materials Manager
Careplex Orthopaedic Ambulatory Surgery Center —Hampton, VA
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12d
Histology Manager
Medipath, LLC —Miramar, FL
- From $120,000 a year
- Full-time
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- English
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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

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

Utilization Management Manager Full Time

Sr. Manager of Member Engagement

Clinical Manager, Global

Pharmacy Operations Manager (Remote)

Utilization Management Manager

Manager, Utilization Review

HOME CARE - RN CASE MANAGER

Nurse Manager Psychiatric Services

Respiratory Therapy Manager

Nurse Manager | Medical Oncology & Medical Specialties

Pharmacy Manager

RN Unit Manager

Nurse Manager - Telemetry

Supervising Pharmacist

Patient Care Manager - Floater (RN)

Radiologic Technologist/ Materials Manager

Histology Manager

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