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Caresource Management Group

60 Caresource Management Group Jobs Hiring Near You

Caresource Management Group

Manager, Life Services

$83K - $132K/yr

Implement and direct the CareSource Life Services coaching and mentoring programs in collaboration ... A minimum of three (3) years of management experience is required * A minimum of three (3) years of ...

Caresource Management Group

AVP, Actuarial Science

$150K - $300K/yr

Drive company strategy and manage actuarial expertise in coordination with other leaders on all aspects of CareSource's actuarial functions. This includes pricing, forecasting, month-end close ...

Caresource Management Group

Managing Actuary

$94K - $164K/yr

Two to three (2 to 3) years or more of management experience is preferred * Two to three (2 to 3) ... CareSource reserves the right to amend this at any time. CareSource is an Equal Opportunity ...

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Infographic showing various job openings at Caresource Management Group in the United States as of August 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 69% Physical, 3% Hybrid, and 28% Remote job distribution.

Manager, Utilization Management - Must have a MA RN License

Caresource Management Group

Remote

$83K - $132K/yr

Full-time

Posted 3 days ago

New

Job description

Job Summary:

The Manager, Utilization Management is responsible for the oversight of all utilization management activities ensuring consistency of services and achievement of utilization targets.

Essential Functions:

  • Assist in coordination and management of the pre-determination process of medical and dental services; ensure the consistent application of criteria for authorization decision, and that decisions to deny or reduce services are made by a health care professional who has appropriate clinical expertise
  • Assist in the development of integrated service delivery to members and oversee utilization management data and processes to maintain industry standards and practices including decisions within allowable timeframes
  • Interact with providers and staff to manage benefits aligned with state-based regulations, NCQA and/or URAC regulations, and CareSource policies
  • Review and revise workflows to maximize efficiencies
  • Monitor productivity and utilization trends
  • Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
  • Regularly report all utilization management regulatory requirements
  • Ensure compliance with and reporting of all regulatory requirements
  • Maintain all utilization management reporting and trend data
  • Analyze under and over utilization information for impact on member quality of care and outcomes and formulate recommendations based on data
  • Develop, maintain and update all departmental policies and procedures; ensure notices of adverse action are provided in accordance with required regulations
  • Audit predetermination requests, cases for documentation and interrater reliability per CareSource policy
  • Act as liaison with other departments to assist with research and intervention
  • Perform any other job related instructions, as requested

Education and Experience:

  • Associate's Degree in Nursing is required and Bachelors of Science in Nursing (BSN) is preferred
  • Minimum of five (5) years of clinical experience is required
  • Minimum of five (5) years of experience in one of the following is required: case management, utilization management, and/or quality improvement
  • Two years of utilization management experience is preferred
  • Managed care experience is preferred

Competencies, Knowledge and Skills:

  • Beginning Excel, Word and PowerPoint experience
  • Experience in data analysis and trending
  • Knowledge of utilization management standards and practices
  • Communication skills
  • Management and prior supervisory skills
  • Ability to work independently and within a team environment
  • Attention to detail
  • Familiarity of the health care field
  • Critical listening and thinking skills
  • Training/teaching skills
  • Strategic management skills
  • Negotiation skills/experience
  • Proper grammar usage
  • Change resiliency
  • Technical writing skills
  • Time management skills
  • Proper phone etiquette
  • Customer service oriented
  • Decision making/problem solving skills
  • Leadership experience and skills

Licensure and Certification:

  • Current, unrestricted licensure in state of practice as a Registered Nurse (RN) is required

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$83,000.00 - $132,800.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

  • Fostering a Collaborative Workplace Culture

  • Cultivate Partnerships

  • Develop Self and Others

  • Drive Execution

  • Influence Others

  • Pursue Personal Excellence

  • Understand the Business


This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JS2Brand=Commonwealth Care Alliance

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