Top 4725 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
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
Quick Apply
Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)
TMF Health Quality Institute —Remote
- Full-time
- Nursing
- Supervising experience
- Team management
- AD&D insurance
- Disability insurance
Utilization Management Manager Full Time
Kindred Hospitals Mountain District Office —Las Vegas, NV
- Full-time
- Nursing
- Microsoft Outlook
- Hospital
Utilization Review Manager - Remote - Faulkner
Brigham and Women's Faulkner Hospital, Inc. —Boston, MA
- $41.36 - $100.00 an hour
- Part-time
- Remote
- Nursing
- RN License
- Computer literacy
- Opportunities for advancement
Quick Apply
5d
Supervising Pharmacist
Integrea Community Mental Health Systems —Opelika, AL
- Extended hours
- Bachelor of Science
- Residential
- Bachelor's degree
- Dental insurance
- Vision insurance
Quick Apply
Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
- Full-time
- Nursing
- Psychiatry
- RN License
Nurse Manager - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d
Pharmacy Manager
Weis Markets —Burnham, PA
- $94,000 - $155,000 a year
- Full-time
- Background check
- Bachelor of Science
- Mid-level
- Health insurance
- Dental 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
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
Program Manager - Cardiac Rehabilitation
SouthEast Alaska Regional Health Consortium —Juneau, AK
- $36.46 - $51.29 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- BLS Certification
- Paid parental leave
- Disability insurance
Quick Apply
Clinical Site Manager, Physical Therapist
Family Health Centers of San Diego —Lemon Grove, CA
- $90,000 - $154,885 a year
- Full-time
- CPR Certification
- Clean driving record
- BLS Certification
- Paid holidays
- Health insurance
Quick Apply
Case Manager - Bronson Battle Creek Up to 10K Sign On Bonus!
Bronson Healthcare —Battle Creek, MI
- Part-time
- Acute care
- Nursing
- RN License
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
Manager Behavioral Health
CHRISTUS Health (IHE/Hosted) —Longview, TX
- $49,886.84 - $60,078.78 a year
- 8 hour shift
- Nursing
- PALS Certification
- Hospital
- Relocation assistance
Quick Apply
Nurse Manager, Behavioral Health Services
Signet Health Corporation —Greensboro, NC
- $110,000 - $120,000 a year
- Full-time
- Nursing
- Psychiatry
- RN License
- Disability insurance
- Health insurance
Registered Nurse Manager - NCSH Residential
Health Right 360 —Escondido, CA
- $126,000 - $136,500 a year
- Full-time
- Background check
- Nursing
- Patient monitoring
- Commuter assistance
- Paid holidays
Quick Apply
Clinical Supervisor/BCBA
Mass Pediatric Aba LLC —Lowell, MA
- $80 - $90 an hour
- Part-time
- Hybrid work
- Background check
- Mid-level
- Driver's License
- Continuing education credits
- Work from home
Quick Apply
Occupational Health Supervisor
Mountaire Farms —Millsboro, DE
- CPR Certification
- Nursing
- Microsoft Excel
- Profit sharing
- Paid holidays

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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

Sr. Manager of Member Engagement

Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)

Utilization Management Manager Full Time

Utilization Review Manager - Remote - Faulkner

Supervising Pharmacist

Nurse Manager Psychiatric Services

Nurse Manager - Telemetry

Pharmacy Manager

Histology Manager

RN Unit Manager

Program Manager - Cardiac Rehabilitation

Clinical Site Manager, Physical Therapist

Case Manager - Bronson Battle Creek Up to 10K Sign On Bonus!

Clinical Site Manager, Physical Therapist

Manager Behavioral Health

Nurse Manager, Behavioral Health Services

Registered Nurse Manager - NCSH Residential

Clinical Supervisor/BCBA

Occupational Health Supervisor

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

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