Miami, FL · On-site
This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for ...
New
Miami, FL · On-site
This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for ...
New
Utilization Management Professional Location : Miami FL 33126 Duration : 6 months (Contract to Hire) Responsibilities : Under general supervision by management, and in collaboration with Medical ...
Utilization Management Professional Location : Miami FL 33126 Duration : 6 months (Contract to Hire) Responsibilities : Under general supervision by management, and in collaboration with Medical ...
Assures that case documentation for each decision is complete, including related correspondence. - Participates in Care Coordination Team and utilization management activities, including ...
Assures that case documentation for each decision is complete, including related correspondence. - Participates in Care Coordination Team and utilization management activities, including ...
We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida ...
We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida ...
At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience. There will be ...
At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience. There will be ...
The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. * A strong candidate would be familiar with MCG and ...
The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. * A strong candidate would be familiar with MCG and ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides clinical expertise in assessing the ...
Quick apply
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides clinical expertise in assessing the ...
Fort Lauderdale, FL · Remote
$80K - $105K/yr
Payer/insurance-only Utilization Management experience is not eligible * Minimum 3 years of acute care/hospital RN experience * Strong understanding of medical necessity, utilization management ...
Quick apply
Fort Lauderdale, FL · Remote
$80K - $105K/yr
Payer/insurance-only Utilization Management experience is not eligible * Minimum 3 years of acute care/hospital RN experience * Strong understanding of medical necessity, utilization management ...
Cooper City, FL · On-site
Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including ... Utilization Review: a) Apply medical necessity screening criteria and clinical knowledge to ensure ...
Cooper City, FL · On-site
Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including ... Utilization Review: a) Apply medical necessity screening criteria and clinical knowledge to ensure ...
Cooper City, FL · On-site
Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including ... Utilization Review: a) Apply medical necessity screening criteria and clinical knowledge to ensure ...
Cooper City, FL · On-site
Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including ... Utilization Review: a) Apply medical necessity screening criteria and clinical knowledge to ensure ...
Fort Lauderdale, FL · Remote
$80K - $100K/yr
Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement * Excellent communication, analytical, and critical thinking skills
Quick apply
Fort Lauderdale, FL · Remote
$80K - $100K/yr
Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement * Excellent communication, analytical, and critical thinking skills
Key Responsibilities: 1. Leadership and Team Management: * Supervise and mentor a team of Utilization Review Nurses, providing guidance and support to ensure excellent performance. * Foster a ...
Key Responsibilities: 1. Leadership and Team Management: * Supervise and mentor a team of Utilization Review Nurses, providing guidance and support to ensure excellent performance. * Foster a ...
To start with this is a must! -Knowledge of utilization management principles and healthcare managed care. -Experience with medical decision support tools (i.e. Interqual, NCCN or Miliman) and ...
To start with this is a must! -Knowledge of utilization management principles and healthcare managed care. -Experience with medical decision support tools (i.e. Interqual, NCCN or Miliman) and ...
Miami, FL · On-site
All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR Part 460) and are intended to support-rather than replace-the clinical decision-making authority of ...
Miami, FL · On-site
All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR Part 460) and are intended to support-rather than replace-the clinical decision-making authority of ...
Miami, FL · On-site
All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR Part 460) and are intended to support-rather than replace-the clinical decision-making authority of ...
Miami, FL · On-site
All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR Part 460) and are intended to support-rather than replace-the clinical decision-making authority of ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
$37.3K - $48.1K
15% of jobs
$48.1K - $58.9K
8% of jobs
$60.4K is the 25th percentile. Wages below this are outliers.
$58.9K - $69.6K
15% of jobs
The median wage is $76.5K / yr.
$69.6K - $80.4K
20% of jobs
$80.4K - $91.2K
11% of jobs
$96.6K is the 75th percentile. Wages above this are outliers.
$91.2K - $102K
13% of jobs
$102K - $112.8K
5% of jobs
$112.8K - $123.6K
3% of jobs
$123.6K - $134.3K
4% of jobs
$134.3K - $145.1K
3% of jobs
$145.1K - $155.9K
3% of jobs
$37.3K
$85.6K
$155.9K
To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.
A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.
As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.
Full-time
Posted 2 days ago
New
6.5
Based on 9 frontline employees who took The Breakroom Quiz
We are seeking a Manager, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Manager, Utilization Management plays a vital role in overseeing the evaluation and authorization of healthcare services to ensure appropriate, cost-effective care delivery. This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for developing and implementing utilization management policies and procedures to ensure compliance with regulatory requirements and industry standards. The Manager, Utilization Management will lead a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate. The Manager, Utilization Management’s role is vital in ensuring that patients receive the highest quality of care while managing costs for the organization.
Minimum Qualifications:
Preferred Qualifications:
Responsibilities:
Get the full story on Breakroom
Sourced by ZipRecruiter
Health care and social assistance
501 - 1,000 Employees
Miami, FL, US
2001
