Top 44944 Utilization Manager Jobs

Utilization Management Physician Reviewer
Oak Street Health —Illinois
- $174,070 - $374,920 a year
- Full-time
- Remote
- Medicine
- Mid-level
- US work authorization
- Health insurance
- Dental insurance
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
2d
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
12d
Clinical Adjudication Manager (Part C)
TMF Health Quality Institute —Remote
- Weekends as needed
- Nursing
- Writing skills
- Supervising experience
- AD&D insurance
- Disability insurance
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
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
Program Manager EHR Trainer
SCA Health —Remote
- $112,000 - $125,000 a year
- Full-time
- 3 years
- Continuous improvement
- Mentoring
- Disability insurance
- Health insurance
Regulatory Process Manager (IDRE)
PROVIDER RESOURCES INC —Remote
- $125,000 - $175,000 a year
- Full-time
- Remote
- Continuous improvement
- Training & development
- Senior level
Quick Apply
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Utilization Management Clinician - CCR
Capital Blue Cross —Harrisburg, PA
- $32.50 - $61.22 an hour
- Full-time
- Remote
- Addiction Medicine
- RN License
- Writing skills
- Paid holidays
- Health 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
Clinical Analyst Appeals (Remote)
Beth Israel Lahey Health —Charlestown, MA
- $93,142 - $124,800 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Senior Operations Manager, Corrections
Rendevor Dialysis —Remote
- Weekends as needed
- Remote
- Background check
- Ability to lift 50 pounds
- Travel
- Disability insurance
- Health insurance
Quick Apply
Manager, Life Sciences / Healthcare Compliance Consulting
Dovetail Consulting Group —Boston, MA
- $120,000 - $185,000 a year
- Full-time
- Remote
- Writing skills
- Master's degree
- Analysis skills
- Health savings account
- Disability insurance
Quick Apply
Med Mgmt Clinician (contract)
Elevance Health —Remote
- $25.44 - $48.58 an hour
- Contract
- Remote
- LVN
- RN License
- Mid-level
- Health savings account
- Disability insurance
Utilization Review Manager (Contra Costa Health Plan)
County of Contra Costa, California —Martinez, CA
- $195,039.12 - $237,071.27 a year
- Full-time
- Nursing
- RN License
- Office
Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
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
Nurse Manager | Medical Oncology & Medical Specialties
Concord Hospital —Concord, NH
- Full-time
- Acute care
- Nursing
- RN License
- Disability insurance
- Health insurance
Nurse Manager - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d

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Utilization Management Physician Reviewer

Oak Street Health -
Illinois

Apply Now

Job Details

Full-time
$174,070 - $374,920 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Inpatient experience
Utilization management
Resource utilization in healthcare
Medical License
Working with individuals from diverse cultural backgrounds
Care coordination

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Company: Oak Street Health

Title: Full-Time Utilization Management Physician Reviewer

Location: Remote/ Treehouse

Role Description:

This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and procedures. Regardless of the final determination, the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and their care team, which may require coordination with internal and external parties including, but not limited to: requesting providers, external UM and case management staff, internal transitional care managers, employed primary care providers, and regional medical leaders. We strive for clinical excellence and ensuring our patients receive the right care, in the right setting, at the right time.

Core Responsibilities:

Review service requests and document the rationale for the decision in easy to understand language per Oak Street Health policies and procedures and industry standards; types of requests include but not limited to: Acute, Post-Acute, and Pre-service (Expedited, Standard, and Retrospective)
Use evidence-based criteria and clinical reasoning to make UM determinations in concert with an enrolleeâs individual conditions and situation. OSH does not solely make authorization determinations based on criteria, but uses it as a tool to assist in decision making.
Work collaboratively with the Oak Street Health Transitional Care and PCP care teams to drive efficient and effective care delivery to patients
Maintain knowledge of current CMS and MCG evidence-based guidelines to enable UM decisions
Maintain compliance with legal, regulatory and accreditation requirements and payor partner policies
Participate in initiatives to achieve and improve UM imperatives; for example, participate in committees or work-groups to help advance UM efforts at Oak Street and promote a culture of continuous quality improvement
Assist in formal responses to health plan regarding UM process or specific determinations on an as-needed basis
Adhere to regulatory and accreditation requirements of payor partners (e.g., site visits from regulatory & accreditation agencies, responses to inquiries from regulatory and accreditation agencies and payor partners, etc.)
Participate in rounding and patient panel management discussions as required
Fulfill on-call requirement, should the need arise
Other duties, as required and assigned

What are we looking for?

At least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business
Excellent verbal and written communication skills
A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)
Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
3-5 years of clinical practice in a primary care setting
Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
Demonstrated understanding of culturally responsive care
Proven organizational and detail-orientation skills
US work authorization
Someone who embodies being Oaky

What does being Oaky look like?

Radiating positive energy
Assuming good intentions
Creating an unmatched patient experience
Driving clinical excellence
Taking ownership and delivering results
Being relentlessly determined

Why Oak Street Health?

Oak Street Health is on a mission to Rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patientâs communities, and focused on the quality of care over volume of services. Weâre an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission.

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/26/2027

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

Refine Your Search

Utilization Manager jobs

Utilization Management Physician Reviewer

Utilization Review Manager - PRN

Manager, Utilization Review

Clinical Adjudication Manager (Part C)

Care Manager, Concurrent Review (Remote)

Utilization Review Manager - Remote - Faulkner

Program Manager EHR Trainer

Regulatory Process Manager (IDRE)

Utilization Review Specialist

Utilization Management Clinician - CCR

Concurrent Utilization Review Nurse, RN

Clinical Analyst Appeals (Remote)

Senior Operations Manager, Corrections

Manager, Life Sciences / Healthcare Compliance Consulting

Med Mgmt Clinician (contract)

Utilization Review Manager (Contra Costa Health Plan)

Market Physician Executive (MPE) - Atlanta, GA

Program Manager - Cardiac Rehabilitation

Nurse Manager | Medical Oncology & Medical Specialties

Nurse Manager - Telemetry

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