Job Summary Manages prospective and concurrent Utilization Management (UM) programs including prior ... This position reports to the Director of UM and coordinates with Case Management (CM) and Care ...
Job Summary Manages prospective and concurrent Utilization Management (UM) programs including prior ... This position reports to the Director of UM and coordinates with Case Management (CM) and Care ...
Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions about the ... Prepares and presents more complex cases for Medical Director Review. Refer cases to Case ...
Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions about the ... Prepares and presents more complex cases for Medical Director Review. Refer cases to Case ...
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
Support the UM Director and Supervisor in data collection and analysis. * Creates and manage comprehensive reports on utilization and productivity and performance trends. * Reviews the human resource ...
Support the UM Director and Supervisor in data collection and analysis. * Creates and manage comprehensive reports on utilization and productivity and performance trends. * Reviews the human resource ...
Hematologist-Oncologist Senior Medical Director of Utilization Management needed to join a practice in Tucson, AZ. This position is with a group that is committed to providing quality services in ...
Hematologist-Oncologist Senior Medical Director of Utilization Management needed to join a practice in Tucson, AZ. This position is with a group that is committed to providing quality services in ...
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Director/Management Posting #: 1048096 Employee Type: Full-Time Position Summary This position is ... Manages and evaluates the effectiveness of Case Management and Utilization Management systems and ...
Director/Management Posting #: 1048096 Employee Type: Full-Time Position Summary This position is ... Manages and evaluates the effectiveness of Case Management and Utilization Management systems and ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
Yoeme Managed Care Utilization Manager The Yoeme Managed Care Utilization Manager works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work ...
Yoeme Managed Care Utilization Manager The Yoeme Managed Care Utilization Manager works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work ...
Yoeme Managed Care Utilization Manager The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work ...
Yoeme Managed Care Utilization Manager The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work ...
... management and guidance across health care service systems to include Inpatient / Outpatient ... Works with the Executive Director, Deputy Director, Medical Director, and others to develop ...
... management and guidance across health care service systems to include Inpatient / Outpatient ... Works with the Executive Director, Deputy Director, Medical Director, and others to develop ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · On-site +1
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · On-site +1
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Yoeme Managed Care Utilization Manager
Tucson, AZ · On-site
$74K/yr
Job Summary The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million ...
Yoeme Managed Care Utilization Manager
Tucson, AZ · On-site
$74K/yr
Job Summary The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million ...
Director Utilization Management information
What are the key skills and qualifications needed to thrive in the director utilization management position, and why are they important?
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
What is a director utilization management?
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
What are the typical daily responsibilities of a director utilization management?
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
What are the most commonly searched types of Utilization Management jobs in Arizona? The most popular types of Utilization Management jobs in Arizona are:
What are popular job titles related to Director Utilization Management jobs in Arizona? For Director Utilization Management jobs in Arizona, the most frequently searched job titles are:
- Hospice Care Cna
- Remote Cvs Utilization Management Nurse
- Cvs Health Utilization Management Remote
- Executive Director Healthcare
- Director Of Online Education Remote
- Assistant Director Healthcare
- Chapter Medicare
- Flexible Cvs Utilization Management Nurse
- Healthcare Revenue Cycle Manager
- Independent Contractor Remote Utilization Management Nurse
What job categories do people searching Director Utilization Management jobs in Arizona look for? The top searched job categories for Director Utilization Management jobs in Arizona are:
What cities in Arizona are hiring for Director Utilization Management jobs? Cities in Arizona with the most Director Utilization Management job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 22 days ago
Job description
We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Manages prospective and concurrent Utilization Management (UM) programs including prior authorization, concurrent inpatient and continued stay reviews including authorization and management of selected post inpatient care. This position reports to the Director of UM and coordinates with Case Management (CM) and Care Coordination (CC) Managers. The position is responsible for providing assistance with the development of UM desk procedures, training, auditing and implementing UM program policies consistent with contractual and performance management goals.
Education & Experience
Required:
• Registered Nurse with current, unrestricted license for appropriate state (RN)
• 5 years' experience in a clinical setting
• 2 year experience with a managed care program
• 3 years supervisory or management leadership experience in a healthcare environment
Preferred:
• Commercial Managed Care experience
• Master's Degree in Nursing or related field
• Veterans Healthcare or TRICARE Program experience
• Experience with policy development and technical writing
• Experience in budgeting, strategic program management and staff development
Key Responsibilities
• Provides leadership to ensure operational effectiveness and efficiency of prospective and concurrent UM including discharge planning activities to meet and exceed production and service-level goals.
• Provides coaching and oversight to staff to ensure staff success and development.
• Oversees the program quality assurance and quality improvement processes related to UM programs.
• Generates reports to identify trends and opportunities for process improvement.
• Facilitates efforts to enhance UM programs by working collaboratively with the UM Director and other Medical Management leaders to effectively manage contract and internal performance standards.
• Provides assistance with Desk Procedures (DP) development monitors and provides assistance with application use and training programs in support of DPs.
• Collaborates with Data Management staff for data compilation and statistical analysis regarding program outcomes.
• Develops audit reports to identify quality issues and to identify areas for enhanced staff training.
• Develops new training programs, training documents, and flow diagrams to address targeted operational issues.
• Collaborates with clinical leadership to implement new processes for enhancing service levels.
• Assists the UM Director with staffing projections for contract management and budgets.
• Performs other duties as assigned.
• Regular and reliable attendance is required.
Competencies
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Thorough knowledge of health care delivery, clinical quality assurance program metrics, UM, CM,CC, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations.
Working Conditions
Working Conditions:
• Works non-regular hours, as required
• Works remotely, with 10% travel
• Extensive computer work with prolonged sitting
• Department of Defense security clearance required
Company Overview
Taking Care of Our Nation's Heroes.
It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!
Our job is to make sure that America's heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $113,000 - $119,000 per year.
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Manages prospective and concurrent Utilization Management (UM) programs including prior authorization, concurrent inpatient and continued stay reviews including authorization and management of selected post inpatient care. This position reports to the Director of UM and coordinates with Case Management (CM) and Care Coordination (CC) Managers. The position is responsible for providing assistance with the development of UM desk procedures, training, auditing and implementing UM program policies consistent with contractual and performance management goals.
Education & Experience
Required:
• Registered Nurse with current, unrestricted license for appropriate state (RN)
• 5 years' experience in a clinical setting
• 2 year experience with a managed care program
• 3 years supervisory or management leadership experience in a healthcare environment
Preferred:
• Commercial Managed Care experience
• Master's Degree in Nursing or related field
• Veterans Healthcare or TRICARE Program experience
• Experience with policy development and technical writing
• Experience in budgeting, strategic program management and staff development
Key Responsibilities
• Provides leadership to ensure operational effectiveness and efficiency of prospective and concurrent UM including discharge planning activities to meet and exceed production and service-level goals.
• Provides coaching and oversight to staff to ensure staff success and development.
• Oversees the program quality assurance and quality improvement processes related to UM programs.
• Generates reports to identify trends and opportunities for process improvement.
• Facilitates efforts to enhance UM programs by working collaboratively with the UM Director and other Medical Management leaders to effectively manage contract and internal performance standards.
• Provides assistance with Desk Procedures (DP) development monitors and provides assistance with application use and training programs in support of DPs.
• Collaborates with Data Management staff for data compilation and statistical analysis regarding program outcomes.
• Develops audit reports to identify quality issues and to identify areas for enhanced staff training.
• Develops new training programs, training documents, and flow diagrams to address targeted operational issues.
• Collaborates with clinical leadership to implement new processes for enhancing service levels.
• Assists the UM Director with staffing projections for contract management and budgets.
• Performs other duties as assigned.
• Regular and reliable attendance is required.
Competencies
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Thorough knowledge of health care delivery, clinical quality assurance program metrics, UM, CM,CC, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations.
Working Conditions
Working Conditions:
• Works non-regular hours, as required
• Works remotely, with 10% travel
• Extensive computer work with prolonged sitting
• Department of Defense security clearance required
Company Overview
Taking Care of Our Nation's Heroes.
It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!
Our job is to make sure that America's heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $113,000 - $119,000 per year.
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.