Top 5875 Rn Utilization Manager 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
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)
Adventist Health —Roseville, CA
- $59.23 - $81.24 an hour
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
11d
Oncology Prior Authorization Case Manager, Non-RN - Remote
University of Miami —Miami, FL
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
Care Manager RN - Utilization Management (UM) Remote
Highmark Inc. —Pennsylvania
- $68,400 - $105,900 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
10d
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
12d
Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!
Sentara Hospitals —Richmond, VA
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Paid parental leave
Quick Apply
2d
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Valdosta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
Quick Apply
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
Quick Apply
Assistant Director of Nursing (Home Health) – RN or LPN/LVN – $95,000–$115,000/yr FT | Las Cruces
Matrix Home Care Services of New Mexico —Las Cruces, NM
- $95,000 - $115,000 a year
- Full-time
- Background check
- Spanish
- Nursing
- Health insurance
- Paid time off
Quick Apply
5d
Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Georgia
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Adjunct RN (OBGYN) Clinical Instructor
Marsha Fuerst School of Nursing —Bakersfield, CA
- $55 - $60 an hour
- Part-time
- Hybrid work
- Nursing
- RN License
- PALS Certification
- Dental insurance
- Vision insurance
Quick Apply
RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- 8 hour shift
- Background check
- CPR Certification
- Nursing
- Free parking
- Paid holidays
Quick Apply
OR Manager
Green Mountain Surgery Center —Colchester, VT
- $90,000 - $120,000 a year
- No weekends
- Nursing
- Surgery
- RN License
- Free parking
- Health insurance
RN Care Manager - Case Management - Shoreline Hospital
CHRISTUS Health —Corpus Christi, TX
- $27.50 - $46.00 an hour
- Full-time
- Acute care
- Background check
- Master of Social Work
- 403(b) matching
- Relocation assistance
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

Rn Utilization Manager jobs

Senior Manager, Utilization Management

RN Utilization Management

Concurrent Utilization Review Nurse, RN

RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)

Oncology Prior Authorization Case Manager, Non-RN - Remote

Care Manager RN - Utilization Management (UM) Remote

Claims - Care Manager, RN, Claims

Denials & Appeals Administrator (RN)

Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!

Nurse Educator (RN)

Market Physician Executive (MPE)

Market Physician Executive (MPE)

RN Clinical Manager

Patient Care Manager - Floater (RN)

Assistant Director of Nursing (Home Health) – RN or LPN/LVN – $95,000–$115,000/yr FT | Las Cruces

Market Physician Executive (MPE) - Float

Adjunct RN (OBGYN) Clinical Instructor

RN Unit Manager

OR Manager

RN Care Manager - Case Management - Shoreline Hospital

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