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Utilization Management Non Clinical Jobs in Kentucky

Uoflhealth

RN Utilization Review

Louisville, KY

... non-judgmental, and confidential manner Serves as a resource to physicians for clinical management ... utilization management (preferred) Three years' experience with Behavior Health experience ...

UofL Health

RN Utilization Review

Louisville, KY · On-site

Essential Functions: • Promotes optimal management of clinical resources by conducting timely ... non-judgmental, and confidential manner • Serves as a resource to physicians for clinical ...

UofL Health

RN Utilization Review

Louisville, KY · On-site

Essential Functions: • Promotes optimal management of clinical resources by conducting timely ... non-judgmental, and confidential manner • Serves as a resource to physicians for clinical ...

Signature HealthCARE

Utilization Management Nurse RN

Louisville, KY · On-site

$75K - $82K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... Utilization Management Nurses. * Coordinate internal and external health care team activities ... Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience * Certified in Case ...

Abilis Health Plan

Chief Medical Officer

Louisville, KY · On-site +1

  • Medical

... including utilization management, clinical operations, quality, population health, and pharmacy ... nonclinical stakeholders, executives, boards, and external partners. * Demonstrated ability to ...

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All JobsUtilization Management Non Clinical JobsUtilization Management Non Clinical Jobs in Kentucky

Utilization Management Non Clinical information

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

Is utilization management a hard job?

Utilization Management Non Clinical roles involve reviewing healthcare services to ensure appropriate use of resources, which can be challenging due to the need for attention to detail, understanding of medical policies, and decision-making under time constraints. The job requires strong analytical skills, knowledge of healthcare guidelines, and often involves working with electronic health records and insurance policies.

What are popular job titles related to Utilization Management Non Clinical jobs in Kentucky?

For Utilization Management Non Clinical jobs in Kentucky, the most frequently searched job titles are:

What job categories do people searching Utilization Management Non Clinical jobs in Kentucky look for?

The top searched job categories for Utilization Management Non Clinical jobs in Kentucky are:

What cities in Kentucky are hiring for Utilization Management Non Clinical jobs?

Cities in Kentucky with the most Utilization Management Non Clinical job openings:

Utilization Management Non Clinical jobs near you
Infographic showing various Utilization Management Non Clinical job openings in Kentucky as of August 2026, with employment types broken down into 4% As Needed, 83% Full Time, 11% Part Time, and 2% Contract. Highlights an 91% In-person, and 9% Remote job distribution.

Manger Utilization Management & Quality, Peace Hosptial

UofL Health

Louisville, KY • On-site

Full-time

Posted 11 days ago

Job description

Primary Location:
Peace - Louisville
Address:
2020 Newburg Rd.Louisville, KY 40205
Shift:
First Shift (United States of America)
Job Description Summary:
About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
Job Description:
Position Summary and Purpose
The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This role ensures appropriate resource utilization, regulatory compliance, and alignment with clinical and financial goals. The Manager collaborates with medical staff, case management, revenue cycle, and IT to optimize care delivery and reimbursement.
Essential Functions:
1. Manage the day-to-day operations of the utilization review staff, including training, performance evaluation, and setting performance standards.
2. Create, implement, and maintain policies and procedures for the UM program, ensuring they align with regulations and organizational goals
3. Analyze UM metrics, identify trends, and prepare reports for senior management or quality improvement committees to guide decision-making and demonstrate the impact of the program.
4. Monitor the clinical review process to ensure patient care is appropriate, effective, and timely, and collaborate with physicians, case management and other professionals to improve utilization.
5. Identify opportunities to enhance the efficiency and accuracy of UM processes, often by working with physician advisors, case management, nursing leadership, and revenue cycle.
6. Ensure the department complies with all applicable state and federal guidelines and manage audits from regulatory agencies or health plans.
7. Provide mentorship, training and performance evaluations.
8. Ensure accurate documentation and data capture for billing and compliance.
9. Facilitate secondary reviews and appeals processes.
10. Performs other duties as assigned.
Other Functions:
• Participate in UM system-wide UM committees and initiatives.
• Analyze utilization trends and recommend process improvements.
• Coordinate certified training programs (e.g., InterQual, MCG).
• Partner with IT to optimize UM-related systems (e.g., EMR, InterQual).
Additional Job Description:
Job Requirements
(Education, Experience, Licensure and Certification)
Education: Bachelor's degree in nursing or related field, master's degree preferred.
License: Active RN license or LCSW required to practice in the state of Kentucky.
Certification: Case/Utilization Management (e.g., ACM, CCM, CMAC).
Experience: Minimum seven years of UM/Case Management experience in an acute care of academic health system. Minimum 4 years leadership experience.
Job Competency:
Knowledge, Skills, and Abilities critical to this role:
• Strategic thinking
• Deep understanding of clinical workflows and regulatory requirements.
• Strong communication and stakeholder engagement skills.
• Data-driven decision-making and continuous improvement mindset.
UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
• Honoring and caring for the dignity of all persons
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of UofL Health

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