Top 6159 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
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
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
Utilization Management Registered Nurse
Humana —Georgia
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Utilization Review Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Clinical Review & Correspondence RN
Cohere Health —Remote
- $31 - $35 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Telehealth Triage Registered Nurse (RN)
Lumina Care —Remote
- $38 - $45 an hour
- Weekends as needed
- Remote
- Nursing
- Psychiatry
- RN License
- Paid holidays
- Health insurance
Quick Apply
Patient Care Manager 3D/3E/Burn
Arkansas Children's Hospital —Little Rock, AR
- Full-time
- Nursing
- Surgery
- RN License
Program Manager Trauma RN - Trauma Services
McLaren Greater Lansing —Lansing, MI
- $35.84 - $53.75 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
12d
RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Free parking
- Paid holidays
Quick Apply
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Branch Clinical Manager (RN) Home Health
Adaptive Home Health —Detroit, MI
- Full-time
- RN License
- Home Health
- Senior level
Quick Apply
Utilization Review Nurse
HAMASPIK CHOICE INC —Spring Valley, NY
- $45 - $47 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Clinical Nurse Manager
Centennial Surgery Center —Voorhees, NJ
- $60 - $63 an hour
- Full-time
- Background check
- Nursing
- Surgery
- Health savings account
- Paid holidays
Quick Apply
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
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
Care Manager - Registered Nurse
Crouse Hospital —Syracuse, NY
- $80,000 - $86,000 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Clinical Manager
United Energy Workers Healthcare —Kansas City, MO
- $38 - $43 an hour
- Nights as needed
- CPR Certification
- RN License
- BLS Certification
10d
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
RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN
Ballad Health —Johnson City, TN
- Weekends as needed
- Nursing
- RN License
- PALS Certification

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Senior Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

Apply Now

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

Nurse Case Manager, Utilization Management

Denials & Appeals Administrator (RN)

Utilization Management Registered Nurse

Utilization Review Nurse

Clinical Review & Correspondence RN

Telehealth Triage Registered Nurse (RN)

Patient Care Manager 3D/3E/Burn

Program Manager Trauma RN - Trauma Services

RN Unit Manager

HOME CARE - RN CASE MANAGER

Branch Clinical Manager (RN) Home Health

Utilization Review Nurse

Clinical Nurse Manager

Market Physician Executive (MPE) - Float

Patient Care Manager - Floater (RN)

Care Manager - Registered Nurse

Clinical Manager

RN Clinical Manager

RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN

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

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