- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 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
- CVS Health (Charleston, WV)
- …**Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more
- CVS Health (Little Rock, AR)
- …**Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and ... Registered Nurse. + 3+ years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership experience (formal or informal… 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
- 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
- CVS Health (Oklahoma City, OK)
- …+ 5+ years of clinical practice experience in behavioral healthcare + 2+ years utilization management experience is required + 2+ years of experience with ... we do it all with heart, each and every day. **Position Summary** The Manager , UM Clinical Services, conducts oversight and management of clinical team processes… 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
- 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
- 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
- Healthfirst (NV)
- The Case Manager , Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge ... planning, and case management as assigned. The Case Manager , Utilization Management is also responsible for efficient utilization of health services… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Dignity Health (Rancho Cordova, CA)
- …, and efficient pharmacy services across various ambulatory settings. The Manager oversees utilization management , streamlines pharmacy procurement ... including, but not limited to: drug procurement, preparation, prescription renewal, utilization management , patient assistance and associated pharmaceutical care… 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
- Trinity Health (Chelsea, MI)
- …Part time **Shift:** Rotating Shift **Description:** **Registered Nurse** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, ... **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more
- Trinity Health (Silver Spring, MD)
- …Full time **Shift:** Day Shift **Description:** **RN Manager - Case Management & Utilization Management ** **Location:** Holy Cross Health **Schedule:** ... is seeking a dynamic and experienced **RN Manager - Case Management & Utilization Management ** to lead our inpatient care coordination and utilization… more
- Ellis Medicine (Schenectady, NY)
- …Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge ... per CMS Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates with Case Managers and other… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. The Role:The Medical Clinical Program Manager will focus on utilization management compliance and audit ... 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal...of HMM Quality and Compliance team, the Clinical Program Manager works through the influence as an individual contributor… more
- Evolent (Trenton, NJ)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
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