Top 35573 Utilization manager Jobs

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
Utilization Review Nurse
Nora Concierge Care —Syracuse, NY
- $65 an hour
- Contract
- RN License
- BLS Certification
- HIPAA
Quick Apply
11d
Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
4d
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
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
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 Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Case Manager
Luminare Health —Remote
- $57,800 - $108,500 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Outlook
- Paid parental leave
- Paid holidays
Telehealth Registered Nurse (Telework)
LifeHealth LLC —Remote
- From $33.50 an hour
- 8 hour shift
- Remote
- RN License
- Clinic experience
- 3 years
- AD&D insurance
- Paid holidays
Quick Apply
7d
Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)
TMF Health Quality Institute —Remote
- Full-time
- Nursing
- Supervising experience
- Team management
- AD&D insurance
- Disability insurance
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
RN Case Manager
Zócalo Health —Los Angeles, CA
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental 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
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
Analytical Chemist
Orion Engineered Carbons GmbH —Belpre, OH
- English
- Bachelor's degree
- Senior level
Market Physician Executive (MPE)
Monogram Health Professional Services —Valdosta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Physician Opportunities
Summit Medical Consultants LLC —Colorado Springs, CO
- $300,000 - $350,000 a year
- Weekends as needed
- Medicine
- Skilled nursing facility
- Nursing home
- Health savings account
- Relocation assistance
Quick Apply
Nurse Manager Psychiatric Services
Concord Hospital —Franklin, NH
- Full-time
- Nursing
- Psychiatry
- RN License
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply

I want to receive the latest job alert for 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

utilization manager jobs near

Nurse Case Manager, Utilization Management

1199SEIU Family of Funds -
New York, NY

Apply Now

Job Details

Full-time
$89,400 - $106,100 a year

Qualifications

RN License
Medical-surgical
Utilization management
Bachelor of Science in Nursing
Resource utilization in healthcare
Bachelor's degree in nursing

Full Job Description

Requisition #:

7440

# of openings:

Employment Type:

Full time

Position Status:

Permanent

Category:

Non-Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199SEIU National Benefit Fund

Job Classification:

Exempt

Responsibilities

Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach
Performs medical necessity review that includes concurrent, prospective, retrospective reviews and 1st level appeals, to ensure compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts.
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization
Maintain accurate records of all patient/provider/vendor related interactions in designated medical management system
Apply clinical guidelines, provide recommendations and discuss cases with Medical Consultants
Meet timelines and quality standards related to Utilization Management
Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures,
Identify and participate in quality improvement activities as it relates to internal programs, processes studies and projects
Authorize vendor services using clinically proven criteria to make consistent care decisions
Maintain compliance with all state mandated regulations
Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
Perform additional duties and projects as assigned by management

Qualifications

Bachelor’s degree Valid New York State Registered Nurse (RN) required
Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Utilization Management experience required
BSN and Certification in Case Management a plus
Proficient in application and use of industry standard Utilization Management criteria (Milliman Care Guidelines), Medicare and coverage guidelines, health claims processing, medical coding
Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
Computer and organizational skills required, ability to manage competing priorities, multi-task with results-oriented outcomes and work in a fast paced environment. Intermediate skills of Microsoft Office systems preferred.

Apply Now

Refine Your Search

utilization manager jobs

Nurse Case Manager, Utilization Management

Utilization Review Nurse

Utilization Review Nurse

Utilization Review Manager - PRN

Manager, Utilization Review

Clinical Review & Correspondence RN

Utilization Management Clinician - CCR

Utilization Review Specialist

Case Manager

Telehealth Registered Nurse (Telework)

Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)

Care Manager - Utilization Management (Must Have UAS Experience)

RN Case Manager

Program Manager EHR Trainer

Market Physician Executive (MPE) - Atlanta, GA

Analytical Chemist

Market Physician Executive (MPE)

Physician Opportunities

Nurse Manager Psychiatric Services

Market Physician Executive (MPE)

I want to receive the latest job alert for utilization manager

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected