- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management , Nurse Case Manager /Caseworker,… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Shift:** Day **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key to ensuring patients… more
- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ \#LI-TB1 IND567 **Union:** Non Bargained **Position** Manager Utilization Management - Utilization ... **SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH,… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license as a… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Jul 15, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... services, health care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of utilization review,… 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 ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Highmark Health (Sacramento, CA)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... Management Knowledge: A strong understanding of utilization management principles, processes, and industry best practices. + Clinical Knowledge: Familiarity… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
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