Top 591327 Manager utilization mgmt Jobs

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
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
13d
Program Manager EHR Trainer
SCA Health —Remote
- $112,000 - $125,000 a year
- Full-time
- 3 years
- Continuous improvement
- Mentoring
- Disability insurance
- Health insurance
Biologics Manager
MedicoCX —Remote
- $65,000 - $85,000 a year
- Full-time
- Remote
- Nursing
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
6d
Clinic Engagement Manager
THE MAVEN PROJECT —Remote
- $60,000 - $70,000 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
ECM Clinical Manager (RN)
Vynca —Remote
- $90,000 - $125,000 a year
- Weekends as needed
- Background check
- RN License
- Pass drug screening
- Health insurance
- Dental insurance
Epic Patient Access Applications Manager
Xtensys Connected Health Solutions —Remote
- $130,000 - $160,000 a year
- Full-time
- 3 years
- Travel
- Business Administration
Clinical Services Assistant Manager
EMC Insurance —Remote
- $100,085 - $152,122 a year
- Full-time
- Nursing
- RN License
- 8 years
- Work from home
10d
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 Clinical Applications, Monitoring
Nihon Kohden —Remote
- $105,000 - $155,000 a year
- Weekends as needed
- Remote
- Clean driving record
- Travel
- Organizational skills
12d
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
Clinical Site Relationship Manager
IUVO BIOSCIENCE OPERATIONS, LLC —Remote
- $100,000 - $145,000 a year
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
ECM Clinical Manager (LCSW/LMFT)
Vynca —Remote
- $90,000 - $125,000 a year
- Weekends as needed
- Background check
- LMFT
- Pass drug screening
- Health insurance
- Dental insurance
Program Manager, Healthcare Services (Enhanced Care Mgmt - PST hours)
Molina Healthcare —Los Angeles, CA
- $84,067 - $163,931 a year
- Full-time
- LMFT
- Nursing
- LVN
- Health insurance
CTMA Manager
BeiGene —Remote
- $118,600 - $158,600 a year
- Full-time
- Data analysis skills
- Microsoft Office
- Bachelor's degree
- Health savings account
- Employee stock purchase plan
Manager, Market Expansion
Habitat Health —Remote
- $128,000 - $159,000 a year
- Remote
- Writing skills
- Research
- Mid-level
- COVID-19 protective measures
- Paid parental leave
Remote Site Manager
IntraCare Health Center —Remote
- Part-time
- Remote
- Mid-level
- Travel
- Leadership
Quick Apply
4d
Utilization Review Manager
Walker Health Services, LLC —Pikesville, MD
- $0 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Mentoring
Quick Apply
Manager, Government Audit
Health Business Solutions LLC —Remote
- Remote
- 5 years
- Master's degree
- Supervising experience
Medical Billing Manager
Saratoga Schenectady Gastroenterology Associates —Burnt Hills, NY
- $85,000 - $115,000 a year
- Full-time
- HIPAA
- Recruiting
- Contracts
- Health savings account
- Health insurance
Quick Apply

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Nurse Case Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

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Job Details

Full-time
$89,400 - $106,100 a year

Qualifications

RN License
Medical-surgical
Utilization management
Bachelor of Science in Nursing
Resource utilization in healthcare
Bachelor's degree in nursing

Full Job Description

Requisition #:

7440

# of openings:

Employment Type:

Full time

Position Status:

Permanent

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach
Performs medical necessity review that includes concurrent, prospective, retrospective reviews and 1st level appeals, to ensure compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts.
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization
Maintain accurate records of all patient/provider/vendor related interactions in designated medical management system
Apply clinical guidelines, provide recommendations and discuss cases with Medical Consultants
Meet timelines and quality standards related to Utilization Management
Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures,
Identify and participate in quality improvement activities as it relates to internal programs, processes studies and projects
Authorize vendor services using clinically proven criteria to make consistent care decisions
Maintain compliance with all state mandated regulations
Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
Perform additional duties and projects as assigned by management

Qualifications

Bachelor’s degree Valid New York State Registered Nurse (RN) required
Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Utilization Management experience required
BSN and Certification in Case Management a plus
Proficient in application and use of industry standard Utilization Management criteria (Milliman Care Guidelines), Medicare and coverage guidelines, health claims processing, medical coding
Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
Computer and organizational skills required, ability to manage competing priorities, multi-task with results-oriented outcomes and work in a fast paced environment. Intermediate skills of Microsoft Office systems preferred.

Apply Now

Refine Your Search

manager utilization mgmt jobs

Nurse Case Manager, Utilization Management

Manager, Utilization Review

Program Manager EHR Trainer

Biologics Manager

Clinic Engagement Manager

ECM Clinical Manager (RN)

Epic Patient Access Applications Manager

Clinical Services Assistant Manager

Care Manager - Utilization Management (Must Have UAS Experience)

Manager Clinical Applications, Monitoring

CHS Utilization and Appeals Manager

Clinical Site Relationship Manager

ECM Clinical Manager (LCSW/LMFT)

Program Manager, Healthcare Services (Enhanced Care Mgmt - PST hours)

CTMA Manager

Manager, Market Expansion

Remote Site Manager

Utilization Review Manager

Manager, Government Audit

Medical Billing Manager

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