Top 4734 Supv utilization management Jobs

Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
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- Nursing
- Microsoft Outlook
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Registered Nurse - Case Manager
SSM Health —Madison, WI
- Part-time
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- RN License
- Hospital
- Paid parental leave
- Health insurance
Clinical Manager
United Energy Workers Healthcare —Kansas City, MO
- $38 - $43 an hour
- Nights as needed
- CPR Certification
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13d
Manager of Labor Management
Phoebe Putney Health System, Inc. —Albany, GA
- Full-time
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- 5 years
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Registered Nurse Case Manager - Bilingual Spanish
Oak Street Health —Bronx, NY
- $72,627 - $155,538 a year
- Full-time
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Nurse Manager, Behavioral Health Services
Signet Health Corporation —Greensboro, NC
- $110,000 - $120,000 a year
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- Psychiatry
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Home Health Care RN Case Manager
ACE Home Health Care —Howard City, MI
- $65 - $80 a year
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BCBA Clinical Supervisor - Pittsburgh/Bloomfield - Sign on bonus!!
Helping Hands Family —Pittsburgh, PA
- $88,000 - $95,000 a year
- Background check
- Clinic
- Supervising experience
- Continuing education credits
- Health insurance
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Regional Clinical Manager
VITRA Health —Boston, MA
- $130,000 - $140,000 a year
- Full-time
- Nursing
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UM Case Manager/Appeals Coordinator
Havenwyck Hospital (UHS) —Auburn Hills, MI
- $60,000 - $69,000 a year
- Full-time
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Sleep Center Manager
Respiratory Specialists —Wyomissing, PA
- Full-time
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Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
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Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus
Helping Hands Family —Lanham, MD
- $100,000 - $120,000 a year
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- Health insurance
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Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
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- Mid-level
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BCBA Clinical Supervisor - Sign on bonus!!
Helping Hands Family —Penn Hills, PA
- $90,000 - $95,000 a year
- Background check
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Patient Case Manager - IP BH
Munson Healthcare —Traverse City, MI
- Full-time
- LPC
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- Mid-level
- Paid holidays
- Tuition reimbursement
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Utilization Management Manager
Region 10 PIHP —Port Huron, MI
- From $61,200 a year
- Full-time
- Doctoral degree
- Pass drug screening
- Windows
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Urgently Hiring - Radiology Manager Position in a Freestanding ER
LONESTAR 24HR ER —New Braunfels, TX
- From $45 an hour
- Urgently hiring
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Hybrid Clinical Supervisor/BCBA - Federal Hill
Helping Hands Family —Baltimore, MD
- $100,000 - $115,000 a year
- Hybrid work
- Background check
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- Health insurance
Quick Apply
Pharmacy Manager
Weis Markets —Burnham, PA
- $94,000 - $155,000 a year
- Full-time
- Background check
- Bachelor of Science
- Mid-level
- Health insurance
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Care Manager, Concurrent Review (Remote)

EmblemHealth -
New York, NY

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Job Details

$68,040 - $118,800 a year

Qualifications

RN License
Research

Full Job Description

Summary of Position

Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department.
Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.

Principal Accountabilities

Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan.
Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting.
Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care.
Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards.
Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards.
Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication.
Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations.
Prepare and present clinical case summaries in routine inpatient rounds.
Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting.
Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager.
Actively participate on assigned committees.
Perform other related projects and duties as assigned.

Qualifications

Education, Training, Licenses, Certifications

Associate’s degree or bachelor’s degree in nursing.
Valid RN License without restriction.
May require a CME accreditation in specific specialties.
Certification in utilization or care management preferred

Relevant Work Experience, Knowledge, Skills, and Abilities

4 – 6+ years of Nursing experience.
Case and/or utilization management/care coordination and managed care experience.
Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience.
Organizing and prioritizing skills, and strong attention to detail.
Trained in the use of Motivational Interviewing techniques.
Experience working in physician practice and/or with electronic medical records.
Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.).

Additional Information

Requisition ID: 1000002996
Hiring Range: $68,040-$118,800

Apply Now

Refine Your Search

supv utilization management jobs

Care Manager, Concurrent Review (Remote)

Registered Nurse - Case Manager

Clinical Manager

Manager of Labor Management

Registered Nurse Case Manager - Bilingual Spanish

Nurse Manager, Behavioral Health Services

Home Health Care RN Case Manager

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Regional Clinical Manager

UM Case Manager/Appeals Coordinator

Sleep Center Manager

Nurse Manager Psychiatric Services

Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus

Patient Care Manager - Floater (RN)

BCBA Clinical Supervisor - Sign on bonus!!

Patient Case Manager - IP BH

Utilization Management Manager

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Hybrid Clinical Supervisor/BCBA - Federal Hill

Pharmacy Manager

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