Top 4662 Manager Utilization Management Jobs

Utilization Management (UM) Clinical Team Lead
MetroPlusHealth —New York, NY
- $124,836 a year
- Hybrid work
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
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8d
Senior Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $125,400 - $156,700 a year
- Full-time
- Nursing
- 6 years
- RN License
Nurse Case Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $89,400 - $106,100 a year
- Full-time
- Nursing
- RN License
- Mid-level
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
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
Utilization Management Nurse Lead
Humana —Michigan
- $94,900 - $130,500 a year
- Full-time
- Remote
- Nursing
- RN License
- Master's degree
- Paid parental leave
- Paid holidays
9d
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
12d
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
1d
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
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4d
Manager- Utilization Management
ECU Health —Greenville, NC
- $92,206.40 - $134,397.12 a year
- Nursing
- Mid-level
- Master's degree
Utilization Management Manager
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- Nursing
- RN License
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
Manager Utilization Management
Children's of Alabama —Birmingham, AL
- Full-time
- Nursing
- RN License
- Bachelor of Science
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
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
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
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 - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
10d
Registered Nurse - Case Manager
SSM Health —Lake Saint Louis, MO
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance

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Utilization Management (UM) Clinical Team Lead

MetroPlusHealth -
New York, NY

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Job Details

$124,836 a year
8 days ago

Qualifications

High school diploma or GED
Utilization management
Resource utilization in healthcare

Full Job Description

Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview:

The Clinical Team Lead, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Clinical Team Lead will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.

Work Shifts

9:00 AM - 5:00 PM

Duties & Responsibilities

Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.

Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director.
Inform member and provider of Utilization Management determinations and treatment alternatives.
Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
Evaluate member needs for referred cases (from providers or member self-referred).
Assists all departments with the resolution of members' problems related to utilization management issues.
Performs all Utilization Management activities in compliance with all regulatory agency requirements.
Conducts medical record reviews as appropriate to case management functions.
Participate in Medical Management grand rounds with the Physician Advisor.
Performs all other duties as assigned

Minimum Qualifications

High School Diploma General Equivalency Diploma (GED) required; and
2-5 years' clinical experience in an acute or applicable care setting.
UM/UR experience in managed care or hospital setting required

Licensure and/or Certification Required:

Valid New York State license and current registration to practice as a Registered Professional Nurse (RN), License Practical Nurse (LPN), or Physical Therapist (PT) issued by the New York State Education Department (NYSED).

Professional Competencies:

Integrity and Trust
Customer Focus
Excellent communication, written and analytical skills.
Knowledge of computer systems.

#LI-Hybrid #MPH50

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Manager Utilization Management jobs

Utilization Management (UM) Clinical Team Lead

Senior Manager, Utilization Management

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Utilization Management Manager

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Utilization Review Manager - Remote - Faulkner

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Utilization Management Manager

Registered Nurse - Utilization Manager

Manager Utilization Management

Care Manager - Utilization Management (Must Have UAS Experience)

CHS Utilization and Appeals Manager

UM Case Manager/Appeals Coordinator

Manager Behavioral Health

Nurse Manager - Telemetry

Registered Nurse - Case Manager

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