Top 5518 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
ECU Health —Greenville, NC
- $92,206.40 - $134,397.12 a year
- Nursing
- Mid-level
- Master's degree
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
11d
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
Utilization Management Manager
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- Nursing
- RN License
Manager, Utilization Management
GLOBALHEALTH HOLDINGS LLC —Oklahoma City, OK
- Full-time
- RN License
- HIPAA
- Mid-level
- Health insurance
Quick Apply
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
15h
RN Manager, Case Management / Utilization Management
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $104,580 - $127,820 a year
- Full-time
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
11d
Epic Healthy Planet/Compass Rose Manager-Manager, Product Services & Management
Northwell Health —Melville, NY
- $91,400 - $158,100 a year
- Full-time
- Bachelor's degree
- Product management
- Experience equivalent to degree accepted
Manager, Care Management
Humana —Chicago, IL
- $86,300 - $118,700 a year
- Full-time
- Nursing
- Up to 50% travel
- RN License
- Paid parental leave
- Paid holidays
Manager, Clinical Utilization Management & Transitions of Care
Community Health Plan of Washington —Seattle, WA
- $101,740 - $163,800 a year
- Full-time
- Nursing
- RN License
- Office
- Paid jury duty
- Health savings account
Quick Apply
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- 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
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
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
Dental Practice Manager
Confidential —Hudson, MA
- $25 - $32 an hour
- Full-time
- Dental office
- Medical office experience
- HIPAA
- Health savings account
- Health insurance
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
RN, Emergency Department Case Manager
Iredell Memorial Hospital Incorporated —Statesville, NC
- Weekends as needed
- Nursing
- RN License
- Word processing
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

Utilization Management Manager

Manager- Utilization Management

Manager, Utilization Review

Regional Manager Utilization Management

Utilization Management Manager

Manager, Utilization Management

Utilization Review Manager - PRN

RN Manager, Case Management / Utilization Management

Epic Healthy Planet/Compass Rose Manager-Manager, Product Services & Management

Manager, Care Management

Manager, Clinical Utilization Management & Transitions of Care

Care Manager, Concurrent Review (Remote)

Sr. Manager of Member Engagement

Manager Behavioral Health

UM Case Manager/Appeals Coordinator

Dental Practice Manager

RN Unit Manager

Program Manager - Cardiac Rehabilitation

RN, Emergency Department Case Manager

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