- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National certification ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- Children's Hospital Boston (Boston, MA)
- … Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A certification as a Certified ... 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance… more
- Elevance Health (Latham, NY)
- …and experiences:** + Certified Case Manager Certification preferred + Utilization management experience highly recommended + RN license is preferred ... an accommodation is granted as required by law. The ** Utilization Management** **Mgr I (Health Care Management Services)** is...would provide an equivalent background. + Current active unrestricted RN , PA, LSW, LCSW, LPC, LMHC or other accepted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. +… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities: * The Utilization Management Reviewer reports to the Utilization Management Manager . * Conducts timely clinical decision review for ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy * Works… more
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