... Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
... Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
Experience with admissions, intake, utilization management, managed care, or referral development. * Knowledge of behavioral health treatment for children, adolescents, adults, and geriatric ...
Experience with admissions, intake, utilization management, managed care, or referral development. * Knowledge of behavioral health treatment for children, adolescents, adults, and geriatric ...
Experience with admissions, intake, utilization management, managed care, or referral development. * Knowledge of behavioral health treatment for children, adolescents, adults, and geriatric ...
Quick apply
Experience with admissions, intake, utilization management, managed care, or referral development. * Knowledge of behavioral health treatment for children, adolescents, adults, and geriatric ...
Conducts all necessary direct utilization management activities for behavioral health plan members including service coordination for members in crisis, crisis intervention, behavioral health triage ...
Conducts all necessary direct utilization management activities for behavioral health plan members including service coordination for members in crisis, crisis intervention, behavioral health triage ...
Epic Payer Platform (Tapestry, Care Management / Utilization Management) Delivery Model * Flexible to support: * Onsite * Nearshore * Offshore (India) What We're Looking For * Candidates who can hit ...
Quick apply
Epic Payer Platform (Tapestry, Care Management / Utilization Management) Delivery Model * Flexible to support: * Onsite * Nearshore * Offshore (India) What We're Looking For * Candidates who can hit ...
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
UM Medical Director - Casual
California, MO · On-site
$223 - $267/hr
The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with ...
New
UM Medical Director - Casual
California, MO · On-site
$223 - $267/hr
The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with ...
New
Senior Epic Tapestry Consultant
Saint Louis, MO · On-site
$102K - $124K/yr
Senior Epic Tapestry Consultant (Utilization Management / Managed Care) Remote 6-12+ months CTH Role Overview Seeking an experienced Epic Tapestry Certified Consultant to support Utilization ...
Senior Epic Tapestry Consultant
Saint Louis, MO · On-site
$102K - $124K/yr
Senior Epic Tapestry Consultant (Utilization Management / Managed Care) Remote 6-12+ months CTH Role Overview Seeking an experienced Epic Tapestry Certified Consultant to support Utilization ...
UM Medical Director - Casual
California, MO · On-site
$223 - $267/hr
The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with ...
New
UM Medical Director - Casual
California, MO · On-site
$223 - $267/hr
The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with ...
New
Senior Staff Dentist
California, MO · On-site
$175 - $185/hr
ResponsibilitiesClinical Review & Utilization Management * Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance * Interpret dental ...
New
Senior Staff Dentist
California, MO · On-site
$175 - $185/hr
ResponsibilitiesClinical Review & Utilization Management * Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance * Interpret dental ...
New
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
Case management or utilization management experience is preferred. * Excellent communication skills are required. * Candidates must be detail-oriented. * Candidates must be self-driven. Job Summary:
Case management or utilization management experience is preferred. * Excellent communication skills are required. * Candidates must be detail-oriented. * Candidates must be self-driven. Job Summary:
RN Case Manager - Florida
Kansas City, MO · On-site
Geriatric care experience is highly desired * 2 years of discharge planning, utilization management, case management, performance improvement, and/or managed care preferred. * Knowledge of Medicare ...
RN Case Manager - Florida
Kansas City, MO · On-site
Geriatric care experience is highly desired * 2 years of discharge planning, utilization management, case management, performance improvement, and/or managed care preferred. * Knowledge of Medicare ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
PRN/As Needed Care Manager
Joplin, MO · On-site
... Utilization Management experience, preferred Licensure: • Current License in the state of employment, required Certifications: • BLS (CPR) at hire date, required, or within 90 days of hire • ...
Product Manager IV
Kansas City, MO · Remote
Understanding of drug management concepts , including formulary management, utilization management, and cost containment strategies. * Experience with authorizations and adjudication processes
Product Manager IV
Kansas City, MO · Remote
Understanding of drug management concepts , including formulary management, utilization management, and cost containment strategies. * Experience with authorizations and adjudication processes
Manager Utilization Management information
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 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 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 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 popular job titles related to Manager Utilization Management jobs in Missouri? For Manager Utilization Management jobs in Missouri, the most frequently searched job titles are:
- Evening Optum Health Utilization Review
- Registered Nurse Utilization Review
- Telephonic Nurse Case Manager
- Remote Telephonic Nurse
- Temporary Utilization Review Nurse
- Per Diem Utilization Review Nurse
- Registered Nurse No Weekends No Holidays
- No Experience Utilization Management Nurse
- Weekend Physician Advisor Utilization Review
- Temporary Admission Discharge Nurse
What job categories do people searching Manager Utilization Management jobs in Missouri look for? The top searched job categories for Manager Utilization Management jobs in Missouri are:
What cities in Missouri are hiring for Manager Utilization Management jobs? Cities in Missouri with the most Manager Utilization Management job openings:
Hannibal Regional Hospital rating
6.9
Based on 28 frontline employees who took The Breakroom Quiz
549th of 1,055 rated hospitals
Job description
- Graduate of an accredited School of Nursing required
- Bachelors Degree of Science in Nursing preferred
- Current Registered Nurse license in the state of Missouri required
- 3 - 5 years healthcare experience preferred
- Care Management or Utilization Management experience preferred
- BLS (CPR) required or obtained within 90 days of hire
- Certification in Case Management preferred
- Strong verbal and written communication and facilitation skills required
- Strong assessment skills, time management skills, critical thinking skills required
- Advanced computer skills required
- Must have ability to interact effectively with a variety of people and situations at all levels of the organization required
- Knowledge of InterQual criteria preferred
What Hannibal Regional Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
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About Hannibal Regional Hospital
Sourced by ZipRecruiter
Company size
201 - 500 Employees
Headquarters location
Hannibal, MO, US
Year founded
1903