... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
Senior Manager, Utilization Management
Manhattan, NY · On-site
$125K - $156K/yr
... the utilization management, benefits and service coordination and appeal process). • Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to ...
Senior Manager, Utilization Management
Manhattan, NY · On-site
$125K - $156K/yr
... the utilization management, benefits and service coordination and appeal process). • Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
... utilization management, benefits and service coordination and appeal process). Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
Gross Pay (weekly): $2480.0 Taxable Pay (weekly): 2480.0 Non-taxable Pay (weekly): 0.0 RN - CARE MANAGER Location: Bronx, NY Scheduled Hours : 40
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Gross Pay (weekly): $2480.0 Taxable Pay (weekly): 2480.0 Non-taxable Pay (weekly): 0.0 RN - CARE MANAGER Location: Bronx, NY Scheduled Hours : 40
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
... Utilization Management Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, Identify and participate in quality improvement activities as ...
... Utilization Management Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, Identify and participate in quality improvement activities as ...
... Utilization Management Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, Identify and participate in quality improvement activities as ...
... Utilization Management Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, Identify and participate in quality improvement activities as ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Utilization Management Specialist
$31 - $36/hr
The Utilization Management Specialist plays a key role in optimizing healthcare resource utilization and ensuring adherence to quality and compliance standards. This specialist-level position ...
Utilization Management Specialist
$31 - $36/hr
The Utilization Management Specialist plays a key role in optimizing healthcare resource utilization and ensuring adherence to quality and compliance standards. This specialist-level position ...
The Utilization Management Specialist plays a key role in optimizing healthcare resource utilization and ensuring adherence to quality and compliance standards. This specialist-level position ...
The Utilization Management Specialist plays a key role in optimizing healthcare resource utilization and ensuring adherence to quality and compliance standards. This specialist-level position ...
Utilization Management Professional Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your ...
Utilization Management Professional Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your ...
Must have at least 2 years of experience in 2 of the 3 skill sets to be forwarded to the manager; MTLC, Clinical and Utilization. The UMP team consist of 7 people. Must be comfortable working in a ...
Must have at least 2 years of experience in 2 of the 3 skill sets to be forwarded to the manager; MTLC, Clinical and Utilization. The UMP team consist of 7 people. Must be comfortable working in a ...
Participates in Care Coordination Team and utilization management activities, including collaboration with other staff on enrollee cases, and performing data collection, tracking, and analysis ...
Participates in Care Coordination Team and utilization management activities, including collaboration with other staff on enrollee cases, and performing data collection, tracking, and analysis ...
Utilization Management Coordinator
Piscataway, NJ · On-site
$71K/yr
Position Details Position Information Recruitment/Posting Title Utilization Management Coordinator ... Prospective employees should speak with their hiring manager to determine which policies apply to ...
Utilization Management Coordinator
Piscataway, NJ · On-site
$71K/yr
Position Details Position Information Recruitment/Posting Title Utilization Management Coordinator ... Prospective employees should speak with their hiring manager to determine which policies apply to ...
Project Manager, Utilization Review
Parsippany, NJ · On-site
$100K - $125K/yr
... management, utilization data analysis Duties & Responsibilities * Prepare and participate in client review meetings (decks, data summaries, presentations) * Track deliverables, timelines, and client ...
Project Manager, Utilization Review
Parsippany, NJ · On-site
$100K - $125K/yr
... management, utilization data analysis Duties & Responsibilities * Prepare and participate in client review meetings (decks, data summaries, presentations) * Track deliverables, timelines, and client ...
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 New York?
The most popular types of Utilization Management jobs in New York are:
What are popular job titles related to Manager Utilization Management jobs in New York?
For Manager Utilization Management jobs in New York, the most frequently searched job titles are:
- Rn Case Management No Experience
- Registered Nurse Utilization Review
- Registered Nurse No Weekends No Holidays
- Home Based Utilization Review Nurse
- Online Health Information Management Faculty
- Bsn Graduate
- Rn Utilization Management
- Utilization Management Nurse Consultant
- Remote Telephonic Nurse
- Weekend Physician Advisor Utilization Review
What job categories do people searching Manager Utilization Management jobs in New York look for?
The top searched job categories for Manager Utilization Management jobs in New York are:
What cities in New York are hiring for Manager Utilization Management jobs?
Cities in New York with the most Manager Utilization Management job openings:
Job description
Responsibilities
Effectively manage the daily operations, workflow, and supervise clinical and non-clinical staff to provide support for the utilization management, benefits and service coordination and appeal process).
Assist in developing strategic plan by partnering with Director/Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes.
Access and analyze all processes on an ongoing basis to determine their effectiveness, eliminate inefficiencies, and make recommendations to senior management to improve workflow, operations, and staff performance.
Coordinate activities between clinical programs, communication, and report requirements to maintain operational efficiencies and to be in compliance with the Department of Labor (DOL), Summary Plan Description (SPD) departmental protocols and clinical policies and procedures.
Interact and collaborate with other departments in troubleshooting, problem solving, and exchanging information in conjunction with maintaining effective communication with providers and members.
Participate in interdepartmental committees/meetings.
Lead internal audits for designated unit
Develop and maintain ongoing quality insurance process
Responsible for staff development, clinical orientation, ongoing education, and training programs to meet the changing needs of the Department.
Continually assess clinical staff performance against internal and external departmental and industry standards.
Perform additional duties and projects as assigned by managed
Qualifications
Bachelor's Degree in Nursing, Business or Health Care Administration or equivalent years of work experience required; plus
Current New York State of Registered Nurse (RN) license required
Minimum six (6) years work experience in Utilization/Case Management/Appeals Programs within a managed care organization, to include a minimum of three (3) years progressive leadership and management experience
Experience working with Milliman guidelines or other regulatory protocols, claims processing, medical coding and interpreting provider contracts
Ability to make critical business clinical decisions independently.
Ability to work with automated Prior Authorization system
Intermediate level of Microsoft Office suite applications
Strong critical thinking and analytical skills with effective troubleshooting and problem-solving abilities
Excellent time management and project management skills
Effective verbal and written communication skills
Ability to prioritize and be detail-oriented, multi-task and must strive in fast-paced environment
About 1199SEIU Funds
Sourced by ZipRecruiter
Industry
Insurance services and funds, trusts and financial programs
Company size
501 - 1,000 Employees
Headquarters location
New York, NY, US