$47K - $66K/yr
... Management/ Utilization Management Programs. Position supports staff development and training ... associates in all job classifications without regard to their race, color, religion, creed ...
$47K - $66K/yr
... Management/ Utilization Management Programs. Position supports staff development and training ... associates in all job classifications without regard to their race, color, religion, creed ...
$35K - $47K/yr
About the Role We're seeking a Sr. Account Management Associate to own the onboarding and ongoing ... and utilization of the Rula benefit. If you're energized by building relationships, solving ...
$35K - $47K/yr
About the Role We're seeking a Sr. Account Management Associate to own the onboarding and ongoing ... and utilization of the Rula benefit. If you're energized by building relationships, solving ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
Case Management Social Worker / Nurse Case Manager - Weekday PRN
Hopkinsville, KY · On-site
$21.75 - $28.50/hr
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
This role is essential in promoting quality outcomes, efficient resource utilization, patient ... Associate degree in Nursing required; Bachelor's degree in Nursing preferred. * Current Kentucky RN ...
EDUCATION * Associate's Degree in Nursing (Required) * Bachelor's Degree in Nursing (Preferred ... Certified Case Manager (Preferred) * Certified Professional Utilization Review (Preferred ...
EDUCATION * Associate's Degree in Nursing (Required) * Bachelor's Degree in Nursing (Preferred ... Certified Case Manager (Preferred) * Certified Professional Utilization Review (Preferred ...
Registered Nurse (ED) Case Manager
Corbin, KY · On-site
Associate Degree in Nursing required; Bachelor's Degree preferred. * Three years of nursing experience required; Case Management and Utilization Management experience preferred. * Current Registered ...
Registered Nurse (ED) Case Manager
Corbin, KY · On-site
Associate Degree in Nursing required; Bachelor's Degree preferred. * Three years of nursing experience required; Case Management and Utilization Management experience preferred. * Current Registered ...
$48.43/hr
... of Utilization Management/Discharge Planning, Home Health Care or Case Management; or 2. Associate's degree in Nursing and the equivalent of four (4) years of full-time clinical experience in the ...
$48.43/hr
... of Utilization Management/Discharge Planning, Home Health Care or Case Management; or 2. Associate's degree in Nursing and the equivalent of four (4) years of full-time clinical experience in the ...
Strong time management skills with the ability to meet designated deadlines * Excellent written and ... Graduate of accredited school of nursing with an associate's degree,Bachelor of Science degree or ...
Strong time management skills with the ability to meet designated deadlines * Excellent written and ... Graduate of accredited school of nursing with an associate's degree,Bachelor of Science degree or ...
Experience with utilization management, workforce planning, forecasting, and operational ... associate and customer success. Stay up to date on everything Blackbaud, follow us on Linkedin ...
Experience with utilization management, workforce planning, forecasting, and operational ... associate and customer success. Stay up to date on everything Blackbaud, follow us on Linkedin ...
Case Management, Utilization Management, and Social Work. Through the Triad Model of Care Delivery ... Nursing Diploma/Associate's - Nursing Experience * Supervisor Experience * No Experience Licenses ...
Case Management, Utilization Management, and Social Work. Through the Triad Model of Care Delivery ... Nursing Diploma/Associate's - Nursing Experience * Supervisor Experience * No Experience Licenses ...
We value our talented employees, and whenever possible strive to help one of our associates grow ... Knowledge of Pharmacy Claims and utilization management is a plus * Knowledge of Specialty ...
We value our talented employees, and whenever possible strive to help one of our associates grow ... Knowledge of Pharmacy Claims and utilization management is a plus * Knowledge of Specialty ...
The Position Kaufman, Hall & Associates, LLC, is seeking a Resource Manager to oversee the ... Strong understanding of staffing models, utilization management, and consulting operations
The Position Kaufman, Hall & Associates, LLC, is seeking a Resource Manager to oversee the ... Strong understanding of staffing models, utilization management, and consulting operations
$87K - $104K/yr
This includes formulary selection and maintenance, application of utilization management tools ... Ability to prioritize effectively and collaborate with all levels of associates * Ability to ...
$87K - $104K/yr
This includes formulary selection and maintenance, application of utilization management tools ... Ability to prioritize effectively and collaborate with all levels of associates * Ability to ...
The Associate Medical Director (AMD) plays a key leadership role in ensuring high-quality, patient ... Knowledge of HEDIS, NCQA standards, Medi-Cal, Medicare, and Utilization Management guidelines.
The Associate Medical Director (AMD) plays a key leadership role in ensuring high-quality, patient ... Knowledge of HEDIS, NCQA standards, Medi-Cal, Medicare, and Utilization Management guidelines.
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
$91K - $163K/yr
Current Physician Assistant/Associate license in your state of residence * Current Board ... years of Utilization Management and Utilization Review processes * Experience with Appeals ...
Associate Degree * Bachelor's Degree Education specialization: Nonessential: * Related Discipline ... experience Utilization management experience 2 years directly related experience Credentials:
New
Associate Degree * Bachelor's Degree Education specialization: Nonessential: * Related Discipline ... experience Utilization management experience 2 years directly related experience Credentials:
New
Utilization Management Associate information
What does a utilization management associate do?
A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.
What skills and qualifications are needed to thrive as a utilization management associate?
A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.
What are the typical daily responsibilities of a utilization management associate?
Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.
What is the difference between Utilization Management Associate vs Utilization Review Coordinator?
| Aspect | Utilization Management Associate | Utilization Review Coordinator |
|---|---|---|
| Certifications | Typically requires a healthcare-related certification or license | Often requires similar certifications, such as CCM or RHIA |
| Work Environment | Works in insurance companies, healthcare providers, or managed care organizations | Works in hospitals, insurance companies, or healthcare facilities |
| Job Focus | Assists in reviewing medical necessity and authorization processes | Coordinates and conducts utilization reviews and approvals |
| Common Usage | Used interchangeably in healthcare and insurance settings | Often used in hospital and insurance contexts |
The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.
What are the most commonly searched types of Utilization Management jobs in Kentucky?
The most popular types of Utilization Management jobs in Kentucky are:
What cities in Kentucky are hiring for Utilization Management Associate jobs?
Cities in Kentucky with the most Utilization Management Associate job openings:
Clinical Manager Care Management Org
On-site
Montefiore New Rochelle
$47K - $66K/yr
Other
Posted 9 days ago
Job description
## Clinical Manager Care Management OrgApplylocations: 200 Corporate Boulevardtime type: Full timeposted on: Posted Todayjob requisition id: JR232547**City/State:**Yonkers, New York**Grant Funded:**No**Department:**NCM - Care Management 3**Work Shift:**Day**Work Days:**MON-FRI**Scheduled Hours:**9 AM-5:30 PM**Scheduled Daily Hours:**7.5 HOURS**Pay Range:**$120,000.00-$150,000.00**Job Summary** The Clinical Manager has responsibility for the day to day operations of the multidisciplinary teams created to implement organizational programs. The Clinical Manager supervises nursing, social work, administrative and other professional staff. The Manager ensures that appropriate actions are taken consistent with developed policies and procedures and using available automated systems (e.g. EPIC, CIS, tele-monitoring devices, etc.). The Clinical Manager assists in development of policies, procedures and work flows; monitors work flow and staff effectiveness; assures that appropriate interventions are offered to enrolled beneficiaries & members; assists in program monitoring; and identifies and assists in resolving barriers to successful implementation of the Care Management/ Utilization Management Programs. Position supports staff development and training.**Qualifications**• Bachelor degree in nursing or a health-related field required, Masters degree preferred.• Current active license/registration in New York State as applicable and additional state licenses/registration (NJ, CT, etc.) as required by Program. • Medical Management experience in a managed health care setting preferred. • 5 years of clinical practice, preferably including at least 2 years in an outpatient setting . • Minimum 2 years of supervisory experience. • Professional certification in Case Management, Utilization Management, or Quality Management preferred.• Knowledge of: - Medicare & Medicaid benefits and guidelines - case management concepts - quality improvement techniquesMontefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. #J-18808-Ljbffr