Top 29 Utilization review Jobs in Manchester, Nh

RN Manager Utilization Review- Full Time- Days
Elliot Health System —Manchester, NH
- Full-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
13d
RN Utilization Review - Patient & Family Services - Per Diem
Southern New Hampshire Health —Nashua, NH
- Part-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
Haverhill Pavilion - Utilization Specialist
Haverhill Behavioral Health —Haverhill, MA
- Full-time
- CPR Certification
- Nursing
- RN License
Director Provider Network Management
Amerihealth Caritas —Manchester, NH
- Full-time
- Hybrid work
- Office
- Driver's License
- Bachelor's degree
RN Case Manager- Care Coordination- Full Time
Elliot Health System —Manchester, NH
- Full-time
- Nursing
- Hospital
- 5 years
- Disability insurance
- Health insurance
Registered Nurse, Home Health Program Nurse Coordinator
Greater Lawrence Family Health Center —Methuen, MA
- Nursing
- RN License
- Internal Medicine
- Tuition reimbursement
Quick Apply
Pharmacist
Greater Lawrence Family Health Center —Lawrence, MA
- Part-time
- Spanish
- BLS Certification
- Internal Medicine
- Tuition reimbursement
Quick Apply
Licensed Practical Nurse
TalentBurst, Inc. —Milford, NH
- $1,320 - $1,360 a week
- Contract
- CPR Certification
- Nursing
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
7d
Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm
Merrimack Health —Methuen, MA
- Full-time
- Nursing
- RN License
- Hospital
RN, Acute Care Case Manager - Full Time
Southern New Hampshire Health —Nashua, NH
- Full-time
- Acute care
- Nursing
- RN License
- Paid training
- Disability insurance
Director Inpatient Care Management
Concord Hospital —Concord, NH
- Full-time
- Acute care
- Nursing
- RN License
Registered Nurse Care Manager | Per Diem
Concord Hospital —Concord, NH
- Part-time
- Nursing
- RN License
- Hospital
Board Certified Behavior Analyst (BCBA) - Remote
All Care Therapies —Manchester, NH
- $43 - $56 an hour
- Part-time
- HIPAA
- Psychology
- Mentoring
Quick Apply
14d
Inpatient Registered Nurse Care Manager
Concord Hospital —Concord, NH
- Full-time
- Nursing
- RN License
- Hospital
Registered Nurse - Unit Manager
Cloud Space LLC —Manchester, NH
- $62 - $65 an hour
- Contract
- Nursing
- RN License
- Physical & Rehabilitation Medicine
- Referral program
Quick Apply
Youth MCI Clinical Supervisor
Vinfen —Lowell, MA
- $96,842 a year
- Full-time
- Background check
- Clean driving record
- Management
Quick Apply
RN Admissions PT
Haverhill Behavioral Health —Haverhill, MA
- $40 - $50 an hour
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Paid training
- Health savings account
MDS Registered Nurse
Maple Leaf Healthcare Center —Manchester, NH
- Full-time
- Background check
- Anatomy knowledge
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
3d
Pharmacist - Per Diem
Greater Lawrence Family Health Center —Lawrence, MA
- $23.40 - $26.00 an hour
- Part-time
- Spanish
- BLS Certification
- Internal Medicine
- Tuition reimbursement
Quick Apply
Clinician Family Physician
Greater Lawrence Family Health Center —Lawrence, MA
- On call
- Spanish
- Medicine
- Hospital
Quick Apply

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RN Manager Utilization Review- Full Time- Days

Elliot Health System -
Manchester, NH

Apply Now

Job Details

Full-time
13 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Vision insurance
403(b)
Pet insurance

Qualifications

RN License
InterQual
Stakeholder relationship building

Full Job Description

RN Manager Utilization Review

Who We Are:

Elliot Health System’s Care Coordination Department, located in Manchester, NH, plays a vital role in ensuring seamless, patient-centered care across the healthcare continuum. Our team is dedicated to care management, discharge planning, and patient advocacy, working closely with providers, social workers, and community resources to enhance patient outcomes. By developing individualized care plans, facilitating smooth transitions between care settings, and offering proactive support, we help patients navigate complex healthcare needs while improving overall access to high-quality, coordinated care.

About the Job:

Under the direction of the Director of Care Coordination, the Manager of Utilization Review provides strategic, operational, and clinical leadership for the Utilization Review (UR) function. This role is accountable for program performance, regulatory compliance, denial mitigation outcomes, staff development, and financial stewardship related to utilization management activities. The Manager ensures consistent application of level-of-care criteria, high-quality clinical documentation, timely and accurate payer communication, and integration of utilization review with broader care coordination and organizational goals. This position partners extensively with physician leadership, revenue cycle, quality, compliance, and external payers to optimize patient outcomes and appropriate resource utilization.

What You’ll Do:

Provider leadership and oversight of the utilization review staff and operations to ensure accurate, timely, and
compliant level-of-care determinations and clinical submissions.
Provides second-level review and clinical escalation support, including complex cases, denials, and appeals.
Ensures consistent application of InterQual (or equivalent) criteria and promotes best practices in clinical
documentation.
Directs and monitors denial prevention and mitigation strategies, tracking trends and implementing corrective
action plans.
Maintains accountability for utilization performance indicators, including denial rates, appeal success, length
of stay, and financial impact.
Partners with finance and revenue cycle leaders to understand payer trends and guide strategies that support
organizational financial health.
Ensures compliance with CMS Conditions of Participation, payer contracts, accreditation standards, and
hospital policies.
Actively participates in, Utilization Management Oversight Committees, audits, and regulatory reviews.
Builds and maintains strong working relationships with physicians, nursing leadership, case management,
quality, compliance, and external payers.
Leads data-driven quality improvement initiatives related to utilization management and care coordination
outcomes.
Identifies process inefficiencies and champions innovative solutions to improve patient flow, documentation
quality, and payer communication.
Promotes a learning environment through education, competency development, and evidence-based practice
updates.
Employees are expected to work consistently to demonstrate the mission, vision, beliefs, core values and
standards of behavior of the organization.

Who You Are:

Graduate of an accredited nursing program- Bachelor’s degree in Nursing or higher Nursing degree required. Masters preferred
Managerial experience preferred. Demonstrated knowledge of Utilization Review and InterQual Required. Denials Management, case management, utilization performance outcomes
Leadership and people management skills. Comprehensive knowledge of utilization management practices, including medical necessity determination, level of-care criteria (InterQual), denial prevention, and appeal processes across payers Clinical decision-making skills, Communication and relationship building, Analytical skills, Process Improvement
Active New Hampshire or Compact State RN license required.
CCM or ACM certification preferred.

Why You’ll Love Us:

Health, dental, prescription, and vision coverage for full-time & part-time employees
Short-term, long-term disability, life & pet insurance
Tuition reimbursement
403(b) Retirement savings plans
Continuous earned time accrual

Apply Now

Refine Your Search

utilization review jobs in manchester, nh

RN Manager Utilization Review- Full Time- Days

RN Utilization Review - Patient & Family Services - Per Diem

Haverhill Pavilion - Utilization Specialist

Director Provider Network Management

RN Case Manager- Care Coordination- Full Time

Registered Nurse, Home Health Program Nurse Coordinator

Pharmacist

Licensed Practical Nurse

Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm

RN, Acute Care Case Manager - Full Time

Director Inpatient Care Management

Registered Nurse Care Manager | Per Diem

Board Certified Behavior Analyst (BCBA) - Remote

Inpatient Registered Nurse Care Manager

Registered Nurse - Unit Manager

Youth MCI Clinical Supervisor

RN Admissions PT

MDS Registered Nurse

Pharmacist - Per Diem

Clinician Family Physician

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