Top 44389 Utilization manager Jobs

Product Manager lll - HYBRID 3 days in the office- Health Plan Product experience
Fallon Health —Worcester, MA
- $110,000 - $120,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 5 years
Strategic Accounts Manager
PROCEPT BioRobotics Corporation —Pierre, SD
- $180,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- 5 years
- Opportunities for advancement
Quick Apply
Clinical Documentation Improvement (CDI) Manager
University Medical Center of Southern Nevada —Las Vegas, NV
- $90,584.00 - $144,934.40 a year
- Full-time
- Nursing
- Management
- Hospital
- Free parking
- Relocation assistance
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Sr. Manager, Warehouse Management and Automation Lead
Healthtech Benefits Solutions —Daytona Beach, FL
- $90,000 - $145,000 a year
- Full-time
- Hybrid work
- 6 years
- Analysis skills
- Bachelor's degree
- Health insurance
- Paid time off
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Aerospace Operations Manager
THE LIGHTHOUSE FOR THE BLIND INC —Seattle, WA
- $115,000 - $150,000 a year
- Full-time
- Senior level
- Leadership
- Communication skills
- 403(b) matching
- AD&D insurance
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Sales, Territory Manager – Peripheral – Image Guided Therapy Devices (Phoenix AZ)
Philips —Phoenix, AZ
- $194,750 - $305,000 a year
- Full-time
- Hospital
- 5 years
- Bachelor of Science
- Health savings account
- Employee stock purchase plan
13d
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
3d
Utilization Management Clinician - CCR
Capital Blue Cross —Harrisburg, PA
- $32.50 - $61.22 an hour
- Full-time
- Remote
- Addiction Medicine
- RN License
- Writing skills
- Paid holidays
- Health insurance
Utilization Management Manager Full Time
Kindred Hospitals Mountain District Office —Las Vegas, NV
- Full-time
- Nursing
- Microsoft Outlook
- Hospital
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Manager, Partnerships - Canopie (Remote)
Aeroflow Health —Asheville, NC
- Remote
- 5 years
- HIPAA
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
6d
Manager - Healthcare Vendor Contracts and Analytics
UNITE HERE HEALTH —Las Vegas, NV
- $113,600 - $142,000 a year
- Monday to Friday
- Microsoft Outlook
- Writing skills
- 3 years
- Commuter assistance
- AD&D insurance
Quick Apply
Senior Product Manager – Medication Management (PharmD or RN Preferred)
Cantata Health Solutions, LLC —Remote
- $115,000 - $135,000 a year
- Remote
- Nursing
- 7 years
- RN License
- Disability insurance
- Health insurance
Quick Apply
Program Manager EHR Trainer
SCA Health —Remote
- $112,000 - $125,000 a year
- Full-time
- 3 years
- Continuous improvement
- Mentoring
- Disability insurance
- Health insurance
Supervisor, Medical Call Center – Access Center – Full Time 8 Hour Days (Exempt) (Non-Union)
USC —Los Angeles, CA
- $68,640 - $112,370 a year
- 8 hour shift
- 5 years
- Writing skills
- HIPAA
Clinical Document Integrity Specialist - Part Time - Remote
Duke Health —Mooresville, NC
- Part-time
- Remote
- Nursing
- Doctoral degree
- RN License
- Relocation assistance
Supervisor, Medical Call Center – Access Center – Full Time 8 Hour Days (Exempt) (Non-Union)
Keck Medical Center of USC —Los Angeles, CA
- $68,640 - $112,370 a year
- 8 hour shift
- Background check
- 5 years
- Writing skills
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
Clinical Manager, Global
Spring Health —Remote
- $97,325 - $114,500 a year
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- 3 years
- Health savings account
- Health insurance
Quick Apply
Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
Quick Apply

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Product Manager lll - HYBRID 3 days in the office- Health Plan Product experience

Fallon Health -
Worcester, MA

Apply Now

Job Details

Full-time
$110,000 - $120,000 a year

Qualifications

Managed care
Finance
Managed care organization experience
Health insurance policy knowledge
Bachelor's degree
Insurance regulation
Medicare regulations
Project management experience in healthcare
Managing projects
Healthcare compliance

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Under the direction of the Director of Product Management, the Product Manager III works independently and collaboratively with both internal customers and external stakeholders. The Product Manager III will take high profile and strategic projects from development through implementation. responsible for managing the product portfolio for a specific market segment. This includes developing new product features, enhancements, portfolio revisions and overall product lifecycle management. The position requires a high level of operational as well as strategic focus. The Product Manager III will make recommendations to the Director of Product Management and Product Owner on product changes that will improve competitive positioning, mitigate cost for the member or Fallon Health, streamline or increase integrity of internal processes and that ultimately enhances the overall consumer experience

Responsibilities:

Primary Job Responsibilities:

Demonstrated ability to lead cross-functional teams, facilitate decision-making, and maintain end-to-end accountability for successful product implementations and enhancements.
Collaborate with product ownership and the Actuarial team on the development and submission of annual rate filings.
Strong knowledge of federal and state regulatory requirements, with direct experience engaging with the Massachusetts Health Connector
Comprehensive understanding of Fallon Health systems, including key interdependencies and the dependencies between products, internal platforms, and external vendor partners
Act as the primary subject matter expert and responsible leader for product filings, including product oversight of Evidence of Coverage (EOC), SERFF plan and benefit templates, HIOS submissions, and connector seal of approval submission
Serve as Fallon Health’s lead or key contributor for new product development and implementation initiatives, and partner with product ownership to support the design and execution of customized product solutions
Function as a central liaison across Fallon Health departments, external regulatory bodies, and third-party vendors to address product-related inquiries and resolve issues
Partner with Corporate Communications and regulatory to develop and maintain product collateral; ensure all materials—member, and provider-facing—accurately reflect product design, operational processes, and applicable policies, and benefits.
Develop and deliver internal and external product training to ensure alignment and understanding across stakeholders
Oversee and report on product portfolio performance, including financial results, membership growth and retention, operational effectiveness, clinical utilization, and overall customer experience

Qualifications:

Education:

Bachelor's Degree

License/Certifications

Experience:

5 - 10 years in a healthcare setting and 5+ years as Product/Project Manager. Managed care experience with knowledge of plan operations, IT, finance, actuarial, compliance, product implementation, corporate communications, customer service, provider network management, federal and state health insurance regulations, marketing, product management. government agencies including the Massachusetts Health Connector. Considerable knowledge of Medicare and Subsidized Connector Commercial products is important. Experience with M/S Office, PowerPoint, Excel, SharePoint, and One Drive preferred.

Resources:

Outlook, Microsoft Office Suite, Microsoft PowerPoint, Visio, Sharepoint

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 110,000-$120,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

Apply Now

Refine Your Search

utilization manager jobs

Product Manager lll - HYBRID 3 days in the office- Health Plan Product experience

Strategic Accounts Manager

Clinical Documentation Improvement (CDI) Manager

Sr. Manager, Warehouse Management and Automation Lead

Aerospace Operations Manager

Sales, Territory Manager – Peripheral – Image Guided Therapy Devices (Phoenix AZ)

Utilization Review Manager - PRN

Utilization Management Clinician - CCR

Utilization Management Manager Full Time

Care Manager, Concurrent Review (Remote)

Manager, Partnerships - Canopie (Remote)

Manager - Healthcare Vendor Contracts and Analytics

Senior Product Manager – Medication Management (PharmD or RN Preferred)

Program Manager EHR Trainer

Supervisor, Medical Call Center – Access Center – Full Time 8 Hour Days (Exempt) (Non-Union)

Clinical Document Integrity Specialist - Part Time - Remote

Supervisor, Medical Call Center – Access Center – Full Time 8 Hour Days (Exempt) (Non-Union)

Care Manager - Utilization Management (Must Have UAS Experience)

Clinical Manager, Global

Market Physician Executive (MPE) - Atlanta, GA

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