Ensure timely and accurate submission of internal and external utilization management (UM) reports and audit data. Process Improvement & Reporting * Analyze trends in prior auth denials, delays, and ...
Ensure timely and accurate submission of internal and external utilization management (UM) reports and audit data. Process Improvement & Reporting * Analyze trends in prior auth denials, delays, and ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
Phoenix, AZ · On-site
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
Phoenix, AZ · On-site
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN ED/OBS/ACH *Part Time*
Phoenix, AZ · On-site
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Registered Nurse - Case Manager Inpatient - RN ED/OBS/ACH *Part Time*
Phoenix, AZ · On-site
$90K - $136K/yr
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
... utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which ...
Senior Compliance Specialist
Phoenix, AZ · Remote
$39.18 - $58.28/hr
Oversee utilization management, quality, and network management compliance across the organization. * Execute health plan delegation oversight programs to support CommonSpirit Health's departmental ...
Senior Compliance Specialist
Phoenix, AZ · Remote
$39.18 - $58.28/hr
Oversee utilization management, quality, and network management compliance across the organization. * Execute health plan delegation oversight programs to support CommonSpirit Health's departmental ...
Medical Case Manager
Scottsdale, AZ · On-site
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Medical Case Manager
Scottsdale, AZ · On-site
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Medical Case Manager
Scottsdale, AZ · On-site +1
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Medical Case Manager
Scottsdale, AZ · On-site +1
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Case Manager New! Case Management | PRN | Phoenix ...Read More Quick Apply! Case Management Typ[...]
Phoenix, AZ · On-site
$60 - $80/hr
Monitor day‑to‑day patient status, anticipating potential barriers to discharge, and escalating unresolved issues to Case Management, Manager, or Utilization Management Medical Director per ...
Case Manager New! Case Management | PRN | Phoenix ...Read More Quick Apply! Case Management Typ[...]
Phoenix, AZ · On-site
$60 - $80/hr
Monitor day‑to‑day patient status, anticipating potential barriers to discharge, and escalating unresolved issues to Case Management, Manager, or Utilization Management Medical Director per ...
Medical Case Manager
Scottsdale, AZ · On-site +1
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Medical Case Manager
Scottsdale, AZ · On-site +1
Knowledge of case management practice * Knowledge of the nature and extent of injuries, periods of disability, and treatment needed * Knowledge of URAC standards, ODG, Utilization review, state ...
Manager Care Coordination
Chandler, AZ · On-site
$49.78 - $74.05/hr
Ensures timely completion of patient assessments, discharge planning, utilization management collaboration, documentation, and care transition activities in accordance with organizational standards.
Manager Care Coordination
Chandler, AZ · On-site
$49.78 - $74.05/hr
Ensures timely completion of patient assessments, discharge planning, utilization management collaboration, documentation, and care transition activities in accordance with organizational standards.
Manager Care Coordination
Chandler, AZ · On-site
$49.78 - $74.05/hr
Ensures timely completion of patient assessments, discharge planning, utilization management collaboration,documentation, and care transition activities in accordance with organizational standards.
New
Manager Care Coordination
Chandler, AZ · On-site
$49.78 - $74.05/hr
Ensures timely completion of patient assessments, discharge planning, utilization management collaboration,documentation, and care transition activities in accordance with organizational standards.
New
Manager Utilization Management information
What does a manager utilization management do?
A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the key skills and qualifications needed to thrive as a manager utilization management?
To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.
What are some common challenges faced by a manager utilization management, and how can they effectively address them?
Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.
What is the difference between Manager Utilization Management vs Utilization Review Nurse?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.
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 Manager Utilization Management jobs in Arizona?
For Manager Utilization Management jobs in Arizona, the most frequently searched job titles are:
- Registered Nurse Utilization Review
- Non Clinical Utilization Review
- Evening Utilization Review Nurse
- Remote Utilization Management
- Full Time Cvs Health Utilization Management
- Remote Utilization Review Rn
- Manager Care Management
- No Experience Utilization Review Nurse
- Independent Contractor Remote Utilization Management Nurse
- Evening Optum Health Utilization Review
What job categories do people searching Manager Utilization Management jobs in Arizona look for?
The top searched job categories for Manager Utilization Management jobs in Arizona are:
- Remote Cigna Utilization Review Nurse
- Utilization Review Nurse Compact License
- Manager Optum Utilization Review
- Remote Hca Utilization Review
- Remote Physical Therapy Utilization Review
- Case Manager Utilization Review Nurse
- Freelance International Utilization Review Nurse
- Internship Remote Utilization Review
- Aetna Utilization Review
- Lpn Utilization Review
What cities in Arizona are hiring for Manager Utilization Management jobs?
Cities in Arizona with the most Manager Utilization Management job openings:
Other
Posted 18 days ago
Key responsibilities
Lead and support the Prior Authorization team to ensure effective daily department operations and workflow optimization.
Monitor and manage turnaround time compliance for prior authorization requests according to regulatory standards.
Act as a liaison between the PA team, medical directors, and external stakeholders to resolve issues and promote collaboration.
Job description
As the Prior Authorization (PA) Manager, you will lead a high-performing team focused on ensuring timely, accurate, and compliant prior authorization processing across multiple plans and regulatory frameworks. You’ll drive operational excellence, support a culture of continuous learning and exceptional service, and help facilitate care coordination that directly impacts member outcomes.
Working closely with clinical leadership, your team, and external stakeholders, you’ll ensure that all requests are processed according to CMS, NCQA, and payer turnaround requirements, delivering value to both members and providers.
Job Details:
- Lead and support the Prior Authorization Supervisor and nursing staff to ensure effective daily department operations.
- Also assist in supporting and providing general oversight of Prior Authorization Coordinators – who report directly to Prior Auth Supervisor.
- Serves as the escalation point for complex prior authorization requests or operational concerns.
- Oversee staffing, performance, workflow optimization, and workload distribution across clinical and non-clinical roles.
- Facilitate departmental huddles, 1:1 meetings, and team training in partnership with the PA leadership.
Compliance & Quality Assurance
- Monitor and manage turnaround time compliance for Routine/Standard and Urgent/Expedited PA requests according to CMS, NCQA, and contractual standards.
- Conduct monthly internal audits of staff performance and documentation accuracy; provide coaching and feedback to maintain quality standards (98%+ accuracy goal).
- Ensure timely and accurate submission of internal and external utilization management (UM) reports and audit data.
Process Improvement & Reporting
- Analyze trends in prior auth denials, delays, and workload bottlenecks; propose and implement corrective actions.
- Lead or support process documentation, including SOP reviews, workflow changes, and performance metric tracking.
- Coordinate semi-annual underutilization review and contribute to the development of the UM Work Plan for executive leadership.
Stakeholder Engagement
- Acts as a liaison between the PA Team, Medical Directors, office staff, and physicians to resolve PA-related issues and promote collaboration.
- Providing ongoing training and mentorship to new hires and existing staff, emphasizing customer service, regulatory compliance, and AZPC policies.
- Support the Director of Clinical Services Operations in preparation for audits by CMS, health plans, or NCQA.
Job Requirements:
- Graduated from an accredited Registered Nurse (RN) Program.
- Current, unrestricted RN License in the State of Arizona.
- 5+ years of experience in Utilization Management with comprehensive knowledge of prior authorization processes.
- 3+ years of leadership or supervisory experience in a managed care or payer environment.
- Solid understanding of Medicare, Medicaid, and state/federal managed care regulations, including NCQA Utilization Management standards.
- Strong working knowledge of Medicare, state and federal managed care regulations, and NCQA guidelines.
- Proven ability to communicate clearly and professionally in both verbal and written formats – critical for coordinating across clinical teams, providers and payers.
- Demonstrated attention to detail and documentation accuracy, especially important for regulatory compliance and audit preparedness.
- Strong analytical and problem-solving skills to identify workflow gaps and implement effective process improvements.
- Ability to prioritize and manage competing tasks in a high-volume environment with minimal supervision.
- Proficient in Microsoft Office tools (Outlook, Word, Excel, PowerPoint)