Top 6719 Utilization management rn Jobs

Utilization Management (UM) Clinical Team Lead
MetroPlusHealth —New York, NY
- $124,836 a year
- Hybrid work
- RN License
- Physical & Rehabilitation Medicine
- Mid-level
Quick Apply
10d
Clinician, Denials Prevention - Remote
Med-Metrix —Garden City, NY
- $80,000 - $85,000 a year
- Full-time
- Remote
- RN License
- Customer service
- Writing skills
6d
RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Utilization Review Nurse
Nora Concierge Care —Syracuse, NY
- $65 an hour
- Contract
- RN License
- BLS Certification
- HIPAA
Quick Apply
10d
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
10d
Clinical Guide Part A: Utilization Management Nurse
Devoted Health —Remote
- $85,000 - $95,000 a year
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
- Dental insurance
- 401(k)
10d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
10d
Health Nurse - Utilization Management
Alterwood Health —Remote
- $75,000 - $95,000 a year
- Full-time
- Microsoft Word
- Background check
- Nursing
- Health savings account
- Disability insurance
Quick Apply
12d
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
Medical Management - Medical Review Examiner Nurse 135-1009
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
10d
Medical Peer Reviewer
Healthfirst —Remote
- $122,907 - $188,020 a year
- 8 hour shift
- Medicine
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Clinical Auditor I-Nurse
WellSense Health Plan —Remote
- $64,000 - $93,000 a year
- Full-time
- Nursing
- RN License
- Bachelor's degree
- Health insurance
- Dental insurance
RN Reviewer
Cohere Health —Remote
- $33 - $35 an hour
- Full-time
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Utilization Management Clinical Reviewer
CuraFi —Remote
- $140,000 - $160,000 a year
- Full-time
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
12d
Case Manager
Luminare Health —Remote
- $57,800 - $108,500 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Outlook
- Paid parental leave
- Paid holidays
Clinical Documentation Specialist
Managed Resources, Inc (MRI) —Remote
- $32 - $45 an hour
- Full-time
- Remote
- Anatomy knowledge
- RN License
- Mid-level
- Paid holidays
- Health insurance
11d
Utilization Review Nurse
Health Business Solutions LLC —Remote
- Remote
- Nursing
- RN License
- Bachelor of Science
12d
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

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Utilization Management (UM) Clinical Team Lead

MetroPlusHealth -
New York, NY

Quick Apply

Job Details

$124,836 a year
10 days ago

Qualifications

High school diploma or GED
Utilization management
Resource utilization in healthcare

Full Job Description

Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview:

The Clinical Team Lead, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Clinical Team Lead will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.

Work Shifts

9:00 AM - 5:00 PM

Duties & Responsibilities

Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.

Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director.
Inform member and provider of Utilization Management determinations and treatment alternatives.
Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
Evaluate member needs for referred cases (from providers or member self-referred).
Assists all departments with the resolution of members' problems related to utilization management issues.
Performs all Utilization Management activities in compliance with all regulatory agency requirements.
Conducts medical record reviews as appropriate to case management functions.
Participate in Medical Management grand rounds with the Physician Advisor.
Performs all other duties as assigned

Minimum Qualifications

High School Diploma General Equivalency Diploma (GED) required; and
2-5 years' clinical experience in an acute or applicable care setting.
UM/UR experience in managed care or hospital setting required

Licensure and/or Certification Required:

Valid New York State license and current registration to practice as a Registered Professional Nurse (RN), License Practical Nurse (LPN), or Physical Therapist (PT) issued by the New York State Education Department (NYSED).

Professional Competencies:

Integrity and Trust
Customer Focus
Excellent communication, written and analytical skills.
Knowledge of computer systems.

#LI-Hybrid #MPH50

Quick Apply

Refine Your Search

utilization management rn jobs

Utilization Management (UM) Clinical Team Lead

Clinician, Denials Prevention - Remote

RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

Utilization Review Nurse

Medical Management - Utilization Management RN 145-2026

Clinical Guide Part A: Utilization Management Nurse

Medical Management - Utilization Management RN 145-2011

Health Nurse - Utilization Management

Denials & Appeals Administrator (RN)

Medical Management - Medical Review Examiner Nurse 135-1009

Medical Peer Reviewer

Utilization Management Nurse

Clinical Auditor I-Nurse

RN Reviewer

Utilization Management Clinical Reviewer

Case Manager

Clinical Documentation Specialist

Utilization Review Nurse

Clinical Review & Correspondence RN

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