- CHRISTUS Health (San Antonio, TX)
- …for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and evaluation of ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Sep 26, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... services, health care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of utilization review,… more
- Elevance Health (Washington, DC)
- …office 4 days each week. The office is located at 609 H. Street NE.** The ** Utilization Management ** ** Manager ll** is responsible for managing a team of ... and acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary… more
- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Humana (Augusta, ME)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational and Experience Requirements: MA/MS ... Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of...summ ar ize d ata wit h in the Utilization M an agementSys tem to pr eparere por… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization - ... information visit www.westanaheimmedctr.com. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226814/case- manager utilization - ... community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...admission and across the continuum of the health care management . Works on behalf of the advocate, promoting cost… more
- Prime Healthcare (Chino, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226811/case- manager -%28rn%29 utilization - ... preferred, and community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the… more
- Actalent (Santa Barbara, CA)
- …unit, such as Mental/Behavioral Health services. Skills: Care plans, Case Manager , Pediatrics, Utilization Management , Clinical Reviews Experience ... Remote Utilization Management RN Leading healthcare facility that aims to improve the health and wellness of those in need is now looking for a REMOTE Health… more
- Molina Healthcare (WA)
- …unrestricted State RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
- Dayton Children's Hospital (Dayton, OH)
- …Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization Management , the Utilization ... information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the...a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan… more
- Centene Corporation (Phoenix, AZ)
- …ensure appropriate care to members. Oversees and works with senior leadership on utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management… more
- Amazon (Seattle, WA)
- …the AWS cloud. We're seeking an experienced Technical Infrastructure Program Manager to oversee data center electrical infrastructure optimization projects. The ... Technical Infrastructure Program Manager will lead cross-functional... will lead cross-functional and technical teams identify sub-optimal utilization , determine root causes, design solutions and drive project… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- Ellis Medicine (Schenectady, NY)
- …beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . * Utilization Management Activities; Collaborates with Case Managers ... to make post discharge arrangements for patients. Assists Case Manager or Social Worker by offering choice of providers....and other team members for optimal Utilization Management information throughout the continuum. Maintains… more
