Top 45311 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
Senior Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $125,400 - $156,700 a year
- Full-time
- Nursing
- 6 years
- RN License
Case Manager - Care Management
Legacy Health —Gresham, OR
- $54.37 - $81.21 an hour
- On call
- Nursing
- RN License
- BLS Certification
Nurse Manager of Case Management
Clinical Management Consultants —Stanfield, OR
- $125,020 - $157,030 a year
- Full-time
- Hospital
- Continuous improvement
- Senior level
- Health insurance
- Retirement plan
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Sr. Manager of Member Engagement
Private Health Management —Remote
- $120,000 - $180,000 a year
- US work authorization
- Senior level
- Leadership
- 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
14d
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
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Director, Utilization Management Operations
Devoted Health —Remote
- $182,000 - $248,000 a year
- Full-time
- Remote
- Travel
- In-person
- Senior level
- Dental insurance
- 401(k)
Mgr Denials Management
Brown University Health —Providence, RI
- $97,718.40 - $195,436.80 a year
- 8 hour shift
- Remote
- RN License
- 5 years
- Writing skills
Manager, Optimization
Oscar Health —Atlanta, GA
- $105,818.40 - $138,886.65 a year
- Overtime
- Remote
- Mid-level
- 3 years
- Master's degree
- Paid parental leave
- Paid holidays
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
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
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
ABA Operational Manager
The World of Behavior LLC —Richmond, VA
- $30 - $60 an hour
- Part-time
- Hybrid work
- HIPAA
- Mid-level
- Organizational skills
Quick Apply
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
11d
Clinical Adjudication Manager (Part C)
TMF Health Quality Institute —Remote
- Weekends as needed
- Nursing
- Writing skills
- Supervising experience
- AD&D insurance
- Disability insurance
Telephonic Case Manager
Enlyte —Texas
- $74,000 - $86,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health savings account
- AD&D insurance

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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

Senior Manager, Utilization Management

Case Manager - Care Management

Nurse Manager of Case Management

RN Case Manager

Sr. Manager of Member Engagement

Program Manager EHR Trainer

Utilization Review Nurse

Care Manager, Concurrent Review (Remote)

Director, Utilization Management Operations

Mgr Denials Management

Manager, Optimization

Clinical Review & Correspondence RN

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

Telehealth Triage Registered Nurse (RN)

ABA Operational Manager

CHS Utilization and Appeals Manager

Manager, Utilization Review

Clinical Adjudication Manager (Part C)

Telephonic Case Manager

I want to receive the latest job alert for utilization manager

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