Top 4692 Manager Utilization Management Jobs

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
General Manager, Product Strategy and Management: EviCore
The Cigna Group —Remote
- $223,000 - $371,600 a year
- Online Application
- Remote
- 8 years
- Bachelor's degree
- Continuous improvement
- Paid holidays
- Health insurance
8d
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
4d
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
Utilization Management Manager
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- Nursing
- RN License
Manager- Utilization Management
ECU Health —Greenville, NC
- $92,206.40 - $134,397.12 a year
- Nursing
- Mid-level
- Master's degree
Case Manager
Luminare Health —Remote
- $57,800 - $108,500 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Outlook
- Paid parental leave
- Paid holidays
(RN) Manager - Utilization Management
UC San Diego Health —San Diego, CA
- $63.51 - $124.43 an hour
- 8 hour shift
- Hybrid work
- Nursing
- RN License
- Writing skills
Registered Nurse - Utilization Manager
Decypher —Wright-Patterson AFB, OH
- $44.92 an hour
- 8 hour shift
- Bachelor of Science
- Mid-level
- Ability to sit for extended periods
Quick Apply
Care Manager - Utilization Management (Must Have UAS Experience)
MetroPlus Health Plan —New York, NY
- $112,351 a year
- Full-time
- Remote
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
Manager of Labor Management
Phoebe Putney Health System, Inc. —Albany, GA
- Full-time
- Hospital
- 5 years
- Master's degree
Care Manager (RN) - Discharge Planning
MaineHealth —Portland, ME
- Email
- Nursing
- RN License
- Hospital
- Paid parental leave
- Parental leave
RN MDS Coordinator/Case Manager
Lake Forest Health & Rehabilitation —Smithfield, RI
- $45 - $48 an hour
- Full-time
- Anatomy knowledge
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
6d
Hospice Registered Nurse Case Manager
Ovation Hospice —Denver, CO
- $45 - $48 an hour
- Part-time
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
5d
Care Manager LSW- PRN
Longview Regional Medical Center —Longview, TX
- Part-time
- Hospital
- Licensed Clinical Social Worker
- Inpatient
- 401(k) matching
Quick Apply
Sleep Center Manager
Respiratory Specialists —Wyomissing, PA
- Full-time
- Background check
- Mid-level
- High school diploma or GED
- Health savings account
- Health insurance
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
Pharmacy Revenue & Business Manager - Pharmacy Administration
Hennepin Healthcare —Minneapolis, MN
- $69.25 - $103.88 an hour
- 8 hour shift
- Hybrid work
- Psychiatry
- Research
- Analysis skills
- Disability insurance
- Health insurance
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
RN Hospice Case Manager
Audubon Hospice Care —Baton Rouge, LA
- Full-time
- Background check
- Vital signs
- HIPAA
- Health insurance
- Dental insurance
Quick Apply

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

Utilization Management Manager

Healthfirst -
New York, NY

Apply Now

Job Details

Full-time
$99,700 - $168,810 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Life insurance

Qualifications

Associate's degree

Full Job Description

The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to Healthfirst’s care management team, members, and outside medical providers.

Duties/Responsibilities:

Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan services
Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions
Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems
Allocate, monitor, and control resources while delegating and monitoring workloads
Develops and analyzes operational and analytical reports to monitor and track operational efficiency
Properly documents utilization management activities and rationale for all decisions in electronic medical records systems
Functions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management
Additional duties as assigned

Minimum Qualifications:

Associate’s degree
RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
Work experience demonstrating verbal and written communication skills
Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook

Preferred Qualifications:

RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
Master’s degree in a related discipline
Demonstrated professionalism and leadership skills along with the ability to train, develop, direct, and support staff
Experience in managed care, case management, identifying alternative care options, and discharge planning across a variety of treatment settings for high risk, complex populations
Certified Case Manager
Interqual, Milliman, and/or TruCare knowledge
Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
Work experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services
Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies.

Compliance & Regulatory Responsibilities: The Manager is responsible for ensuring regulatory compliance with CMS, DOH, internal, and other relevant rules.

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $116,800 - $168,810
All Other Locations (within approved locations): $99,700 - $148,325

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

99700-148325

Apply Now

Refine Your Search

Manager Utilization Management jobs

Utilization Management Manager

General Manager, Product Strategy and Management: EviCore

Utilization Review Manager - PRN

Manager, Utilization Review

Utilization Management Manager

Manager- Utilization Management

Case Manager

(RN) Manager - Utilization Management

Registered Nurse - Utilization Manager

Care Manager - Utilization Management (Must Have UAS Experience)

Manager of Labor Management

Care Manager (RN) - Discharge Planning

RN MDS Coordinator/Case Manager

Hospice Registered Nurse Case Manager

Care Manager LSW- PRN

Sleep Center Manager

Regional Clinical Manager

Pharmacy Revenue & Business Manager - Pharmacy Administration

Nurse Program Case Manager

RN Hospice Case Manager

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