Top 15018 Resource utilization manager Jobs

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
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
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
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
13d
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
Nurse Manager - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d
Histology Manager
Medipath, LLC —Miramar, FL
- From $120,000 a year
- Full-time
- Spanish
- Word processing
- English
- Health savings account
- Relocation assistance
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
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
3d
Assistant Rehab Manager
Promise Care NJ —East Orange, NJ
- $100,000 - $112,000 a year
- Full-time
- Mid-level
- 3 years
- Driver's License
- Continuing education credits
- Health savings account
Quick Apply
Care Manager (RN) - Discharge Planning
MaineHealth —Portland, ME
- Email
- Nursing
- RN License
- Hospital
- Paid parental leave
- Parental leave
Extrusion Manager
Iowa Aluminum Inc —Albia, IA
- Full-time
- 5 years
- Mentoring
- In-person
- Relocation assistance
- Health insurance
Quick Apply
9d
Registered Nurse Manager - NCSH Residential
Health Right 360 —Escondido, CA
- $126,000 - $136,500 a year
- Full-time
- Background check
- Nursing
- Patient monitoring
- Commuter assistance
- Paid holidays
Quick Apply
Aerospace Program Manager
Crane Aerospace & Electronics —Elyria, OH
- Full-time
- Background check
- 5 years
- Bachelor of Science
- Paid holidays
- Disability insurance
Transportation Supervisor
Gold Star Foods —Huntingdon, PA
- Full-time
- Spanish
- Management
- Customer service
Quick Apply
Clinical Supervisor
Murtis Taylor Human Services System —Cleveland, OH
- $58,000 - $65,000 a year
- Weekends as needed
- LMFT
- Nursing
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Nurse Manager, Behavioral Health Services
Signet Health Corporation —Greensboro, NC
- $110,000 - $120,000 a year
- Full-time
- Nursing
- Psychiatry
- RN License
- Disability insurance
- Health insurance
Production Manager
NVT Group —Burlington, WA
- From $100,000 a year
- Full-time
- Analysis skills
- Electrical experience
- Bachelor's degree
- Health savings account
- Health insurance
Quick Apply
Nurse Manager (RN)- Medical/Surgical UNIT - Andalusia Health
Andalusia Health —Andalusia, AL
- Full-time
- Acute care
- Background check
- Nursing
- Health insurance
- Dental insurance
Quick Apply
13d
Studio Finance Manager
Christine Burdick Design —Essex Junction, VT
- $65,000 - $75,000 a year
- Email
- Microsoft Excel
- Mid-level
- Office
- Paid holidays
- Paid time off
Quick Apply
12d

I want to receive the latest job alert for resource utilization manager

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

resource utilization manager jobs near

Nurse Manager jobs in Portland, ME

Utilization Review Nurse jobs in Remote

Production Manager jobs in Burlington, WA

Care Manager jobs in New York, NY

Utilization Review Nurse jobs in Boston, MA

Registered Nurse Manager jobs in Escondido, CA

Clinical Supervisor jobs in Cleveland, OH

Program Manager jobs in Juneau, AK

Nurse Manager jobs in Greensboro, NC

Prior Authorization Specialist jobs in Miami, FL

Registered Nurse Case Manager jobs in Canton, MA

Registered Environmental Health Specialist jobs in California

Registered Behavior Technician jobs in New York, NY

Registered Nurse Case Manager jobs in Morgantown, WV

Registered Nurse Case Manager jobs in Fishkill, NY

Registered Nurse Case Manager jobs in Inland Empire, CA

New Grad Registered Nurse jobs in Victorville, CA

Rn Case Manager jobs in San Francisco, CA

Nurse Rn jobs in Nebraska

Utilization Review Nurse jobs in Alabama

Utilization Review Manager - Remote - Faulkner

Brigham and Women's Faulkner Hospital, Inc. -
Boston, MA

Quick Apply

Job Details

Part-time
$41.36 - $100.00 an hour
5 days ago

Benefits

Opportunities for advancement

Qualifications

RN License
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

Site: Brigham and Women's Faulkner Hospital, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Schedule: Per Diem

Performs the six essential activities of Case Management: Assessment, Planning, Implementation, coordinating, monitoring, and Reassessing through the continuum of care to facilitate a safe, cost-effective transition post-discharge. Performs all aspects of audits and appeals, including the peer-to-peer process.

Perform utilization review to evaluate for the appropriate level of care and fax all insurance reviews timely to prevent denials.
Collaborates with appropriate individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement.
Demonstrates working knowledge of different industry criteria sets like Milliman and InterQual.
Demonstrates in-depth understanding of all insurance plans, including Medicare, Medicaid, other entitlement programs, as well as commercial insurances and other types of plans: PPO, HMO, or indemnity.
Interact with various third-party payers on a daily basis. Fax clinical in payor communication to the right insurer with the right fax number in the right time frame.
Refer cases not meeting the appropriate level of care to the Physician Advisor or EHR.
Review for Observation status and make changes as needed. Accurately facilitate all documentation needed for Medicare status change from inpatient to observation (code 44).
Perform and monitor for quality issues and document in R.L. solutions.
Serves as a resource to staff and physicians for questions about the process of denial of care for Medicare, Medicaid or other insurances.
Reviews cases retrospectively when requested by the finance department to determine if admission relates to continued care for Medicare.
Must be able to function independently in busy environment.
Coordinate, complete, and track all clinical denials and appeals.
Communicates with the attending physician and care coordination nurse around notification of denial of care to gain understanding of the care needs of the patient.

Performs other duties as assigned
Complies with all policies and standards

Qualifications

Bachelor's Degree in Nursing required
Massachusetts Registered Nurse License required
4 or more years of Utilization Review and Case Management experience preferred
6 or more of Acute Care Nursing preferred

Knowledge, Skills and Abilities

Staff adheres to all I C.A.R.E. Standards.
Demonstrates knowledge, skills and abilities to work with various age groups in order to provide a safe discharge plan.
Must be able to provide care for the patient despite psychosocial, educational, or physical disability.
Basic computer skills, experience with Excel and Word, and good computation skills.
Ability to interact and communicate within a diverse community.
Competent with InterQual Criteria.
Competent in Utilization Review, appeals, the peer-to-peer process, and Case Management.
Use critical thinking skills in all interactions and recognize the need to be solution-driven.
Good negotiating skills with insurance companies and third-party payers.
Performs all aspects of discharge planning to the right environment of care, timely.
Proficient in the use of ECare.

Additional Job Details (if applicable)

Remote Type

Remote

Work Location

1153 Centre Street

Scheduled Weekly Hours

Employee Type

Per Diem

Work Shift

Day (United States of America)

Pay Range

$41.36 - $100.00/Hourly

Grade

RN3500

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

2810 Brigham and Women's Faulkner Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Quick Apply

Refine Your Search

resource utilization manager jobs

Utilization Review Manager - Remote - Faulkner

Care Manager, Concurrent Review (Remote)

Oncology Prior Authorization Case Manager, Non-RN - Remote

Manager, Utilization Review

Registered Nurse - Utilization Manager

Nurse Manager - Telemetry

Histology Manager

Program Manager - Cardiac Rehabilitation

RN MDS Coordinator/Case Manager

Assistant Rehab Manager

Care Manager (RN) - Discharge Planning

Extrusion Manager

Registered Nurse Manager - NCSH Residential

Aerospace Program Manager

Transportation Supervisor

Clinical Supervisor

Nurse Manager, Behavioral Health Services

Production Manager

Nurse Manager (RN)- Medical/Surgical UNIT - Andalusia Health

Studio Finance Manager

I want to receive the latest job alert for resource utilization manager

Related Searches

Explore jobs in more locations

Mass General Brigham Competency Framework

Job Seeker Tools

Employer Tools

Browse

Stay Connected