- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Nov 30, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the...health care delivery for vulnerable populations and utilizes this knowledge in developing partnerships to ensure high-level of quality… more
- Elevance Health (Washington, DC)
- …office 4 days each week. The office is located at 609 H. Street NE.** The ** Manager of Utilization Management ** **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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional...to deliver financial results for areas of accountability * Knowledge of or ability to learn financial management… more
- Huron Consulting Group (Chicago, IL)
- …Join our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, ... of the Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines,… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works...assigned work in a timely and accurate manner + Knowledge of the Utilization management … more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Houston Methodist (Houston, TX)
- …payer requirements/issues, and eligibility for state, local, and federal programs + Comprehensive knowledge of utilization management , case management , ... prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Ochsner Health (Jefferson, LA)
- …This job manages expense management , vendor relationships, contract management , standardization and consolidation processes and utilization analysis. ... supply utilization improvements. + Good judgment, organizational and time management skills. + Consulting and group presentation skills. + Ability to travel… more
- Corewell Health (Grand Rapids, MI)
- …on strategies that will promote optimal health within populations. Demonstrates expertise, current knowledge in nursing care and management of a caseload of ... Life Support (BLS) - ARC American Red Cross Ambulatory Care Management Upon Hire required + Case Manager , Certified (CCM) - CCMC Commission for Case Manager … more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health ... Utilization Management Admissions Liaison RN II...current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) American Case Management Association (ACM)… more
- University of Rochester (Rochester, NY)
- …and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management responsibilities for the pharmacy ... locations, and is intended to be a 'line manager ' level of responsibility, covering shifts typical of their...in hospital pharmacy administration + Graduate degree in business management (or another relevant field) Preferred ** KNOWLEDGE ,… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such as admission, ... a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a...identified in the Competencies, Dimensions, Problem solving, and Information Management sections + Knowledge of and ability… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case- manager utilization ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS (AHA) certificate, preferred.5. Knowledge of Milliman… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Hines VA Utilization Management (UM) RN reports to the UM Manager RN. The UM RN demonstrates a high level of clinical practice, knowledge , ... utilization of resources and care coordination. Responsibilities The Utilization Management (UM) Consultant Registered Nurse (RN) demonstrates leadership,… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the...relate to the working DRG developed by the Case Manager /Coder. Assists with special projects as directed or requested… more
- Actalent (Sacramento, CA)
- Job Title: Utilization Management Coordinator Job Description As a Utilization Management Coordinator, you will coordinate and support activities related ... Your role will involve compiling daily inpatient logs, reviewing specified utilization management reports, processing referrals, completing denial letters, and… more
- Sharp HealthCare (San Diego, CA)
- …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more