551 utilization manager jobs found

Job Description Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Job Summary The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases for medical necessity, appropriate class and level of care (LOC). This position works collaboratively with an interdisciplinary team (including physicians, other care providers, payers, etc.) to ensure the patient’s needs are met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the health system’s Utilization Review Plan. Responsibilities And Scope Uses approved criteria and conducts admission review/class change review as trigger by patient admission to the hospital to ensure appropriateness of the setting...

Job Description Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed...

Job Description Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed...

Job Description Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases for medical necessity, appropriate class and level of care (LOC). This position works collaboratively with an interdisciplinary team (including physicians, other care providers, payers, etc.) to ensure the patient’s needs are met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the health system’s Utilization Review Plan. Responsibilities: Uses approved criteria and conducts admission review/class change review as trigger by patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care. Identifies...

Job Description Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases for medical necessity, appropriate class and level of care (LOC). This position works collaboratively with an interdisciplinary team (including physicians, other care providers, payers, etc.) to ensure the patient’s needs are met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the health system’s Utilization Review Plan. Responsibilities: Uses approved criteria and conducts admission review/class change review as trigger by patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care. Identifies...

Join our dynamic Care Management Leadership Team as an on-site manager at our UNC Chapel Hill campus, where you'll lead a skilled group of Care Managers, Social Workers, and Care Management Assistants.    Candidate must be a  Registered Nurse (RN)  or  Licensed Clinical Social Worker (LCSW/LCSWA) Preference given to candidates with acute hospital experience  Monday-Friday schedule during traditional business hours On-call rotation (approximately every five weeks)       Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: Responsible for day-to-day operations for designated Clinical Care Management Department team(s). Provides management direction to Case Managers, Utilization Managers, Clinical Social Workers, Clinical Authorization Specialists, and Operational staff. Accountable for...

52448069 Overview Case Manager 40 hours per week Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care standards and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources. These are just a few highlights of being a nurse at Dartmouth Hitchcock Medical Center and Clinics in New Hampshire. We have loan repayment up to $20,000. We offer Relocation Assistance and a Housing Coordinator to take on the burden of finding a home. We offer generous tuition reimbursement. We have a very popular "earned time" plan. We have extensive CEU/Training programs. Our 8,000 ft Patient Safety and Training Simulation Center is state-of-the-art. Our nurses serve as central figures in the success of our system through our shared governance nursing model. We offer a rigorous, research-focused environment. Dartmouth Hitchcock's Nursing...

BSMBSZUSR287866EXTERNALENUS Post Acute Care Manager ***This is a remote/work from home position. Hire must have their nursing compact/multistate license prior to starting. Job Summary: The Post Acute Care Manager provides care to patients who are discharged to post-acute facilities and maintains a caseload according to productivity standards. This role performs and coordinates work with the patient, family or support members, inpatient case management team, and interdisciplinary care team members during post-acute admission for appropriate utilization of services, length of stay and safe discharge plan. The role communicates regularly on post-acute care of specific patients, as well as population level care and performance.  Essential Functions:  Runs daily reports for transitions of care, make assignments, and review goals of care. Communicates at minimum weekly with skilled nursing facilities to encourage progression of care within an appropriate length of stay....

643 Job Description Job Summary: Assumes responsibility for management of new product requests and additions to the item manager. Formulates and interprets the information to identify products which will improve the safety, quality outcomes, and financial performance of Parkview Health and Supply Chain operations. Recommends viable actionable projects for supply standardization and utilization initiatives to supply chain leadership. Collaborates with recall and backorder processes. Collaborates with Demand Planners to maintain an uninterrupted flow of products. Collaborates with other Supply Chain co‐workers and customers to integrate alignment processes resulting in improved execution and customer experience and organizational capabilities.

Job Description Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: The Care Manager RN plays a crucial role in providing comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication. The Care Manager works collaboratively with healthcare providers, patients, and their families to ensure that patients receive the highest quality of care and support throughout their healthcare journey. Responsibilities: 1. Patient Assessments: a. Conduct comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients'...

Job Description Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Serves as a clinical and management resource for decision making, problem solving, and employee performance reviews in the skilled nursing facility. Acts as liaison between staff, physicians, and management. Also performs direct patient care. Responsibilities: 1. Ensures care delivered to each patient is appropriate and in accordance with physician orders and policy. Documents patient clinical records. 2. Makes staff /room assignments based on patient needs and staff qualifications. Collaborates with managers and other team leaders to flex and coordinate the number of scheduled staff for optimal utilization and productivity within all areas. Assists with monitoring overtime hours. 3. Serves as a clinical and...

locationsSt. Marys Regional Hospital time typePart time posted onPosted 5 Days Ago time left to applyEnd Date: October 9, 2026 (9 days left to apply) job requisition idR184283 Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas. Weekend Coverage - Saturday and Sunday Essential Functions Assessment: Identifies patients using screening criteria and conduct...

locationsIntermountain Health American Fork Hospital time typeFull time posted onPosted 6 Days Ago time left to applyEnd Date: November 6, 2026 (30+ days left to apply) job requisition idR183965 Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas. Job Specifics Application Requirements : Please upload a current resume that includes your work history and relevant...

locationsIntermountain Health Primary Childrens Hospital time typePart time posted onPosted Yesterday time left to applyEnd Date: November 6, 2026 (30+ days left to apply) job requisition idR183955 Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas. Job Specifics Application Requirements : Please upload a current resume that includes your work history and relevant...

locationsIntermountain Health McKay-Dee HospitalIntermountain Health Layton Hospital time typePart time posted onPosted Yesterday time left to applyEnd Date: November 6, 2026 (30+ days left to apply) job requisition idR184663 Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas. Job Specifics Application Requirements: Please upload a current resume that includes...

Job ID: 33086 Description There’s nothing more exciting and rewarding than being able to make a significant, positive difference in someone’s life. At UCLA Health, you’ll experience this joy every day while also enjoying the positive, supportive, and collaborative environment that makes ours one of the most loved workplaces. Join us and find out for yourself.   Using your advanced practice nursing skills, you will be responsible for assessing and coordinating care for a diverse group of patients. You will collaborate and consult with a multi-disciplinary health care team as well as with patients and their families to ensure safe and effective coordination of care. This involves developing and implementing individualized care plans utilizing evidence-based tools for risk stratification to ensure delivery of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital care....

Job ID: 33185 Description The ICM Nurse Lead serves as a senior nurse case manager clinical leader within the Intensive Case Management program and is responsible for providing day-to-day clinical guidance, case consultation, care coordination oversight, workflow support, and clinical escalation management for complex and high-risk patients. The ICM Nurse Lead supports the delivery of a high-touch, longitudinal, interdisciplinary case management model designed to improve patient outcomes, reduce avoidable emergency department visits and hospitalizations, facilitate safe transitions of care, address social determinants of health, and improve coordination across the healthcare continuum. The Nurse Lead serves as a critical bridge between ICM leadership, Nurse Case Managers, Social Workers, Patient Navigators/Care Coordinators, physicians, specialists, inpatient teams, SNFs, home health, behavioral health, and other community partners. The position promotes...

39046100 Description Summary: Develops and leads nursing maternal/perinatal initiatives for the CHRISTUS location. The Program Manager works in conjunction with the Maternal Medical Director to oversee perinatal practice in the facility. The Program Manager also works with regional clinical leaders in the community (through the Regional Advisory Council-RAC) to lead the development and implementation of clinical strategies, policies, and practices throughout the Region and align them with CHRISTUS Health System which are guided by High-Reliability Principles, to achieve nursing standardization, evidence-based practices, operational excellence, and optimal patient care performance. Establishes effective strategies for service line initiatives, education and competency, physician collaboration, integration, outcomes, and resource utilization with the goal of increasing service line growth, efficiency, compliance, safety, and patient experience. Responsibilities: Meets...

locationsWindy Hill Hospital time typeFull time posted onPosted 2 Days Ago job requisition idJR-74353 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Night (United States of America) Click Here to Visit the Windy Hill Hospital Website Hours: FT Nights - 36hrs per week or 3/12s Job Summary: The RN Clinical Charge Nurse is responsible for directing and overseeing the daily activities of the unit on an assigned shift to assure successful safe delivery of care. The Charge Nurse is a...

locationsPaulding Hospital time typeFull time posted onPosted 12 Days Ago job requisition idJR-71250 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Job Summary: Fulltime Night Shift 7p-7a for Paulding Hospital ICU Magnet Designated/Baldrige award/Prism award with 4 Star CMS scores The RN Clinical Charge Nurse is responsible for directing and overseeing the daily activities of the unit on an assigned shift to assure successful safe delivery of care. The Charge Nurse is a...

locationsKennestone Hospital time typeFull time posted onPosted 5 Days Ago job requisition idJR-75698 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Night (United States of America) Job Summary: The RN Clinical Charge Nurse is responsible for directing and overseeing the daily activities of the unit on an assigned shift to assure successful safe delivery of care. The Charge Nurse is a caregiver and often takes modified patient care assignment. They practice in a clinical environment that is...

locationsNorth Fulton Physicians Building time typeFull time posted onPosted Yesterday job requisition idJR-75085 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Shift/Schedule: 8am-4:30pm Monday-Thursday 8am-2:30pm Friday Job Summary: The RN Oncology Infusion Therapy Clinician functions under the direction of the Manager Infusion Therapy or other designated leader. The RN Oncology Infusion Therapy Clinician demonstrates knowledge, competency, and clinical expertise...

locationsCobb Hospital time typePart time posted onPosted Today job requisition idJR-75712 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Shift/Schedule: 730AM - 530PM Location: 677 Church Street, Building 320/340 Marietta, GA Job Summary: The RN Oncology Infusion Therapy Clinician functions under the direction of the Manager Infusion Therapy or other designated leader. The RN Oncology Infusion Therapy Clinician demonstrates knowledge, competency, and clinical...

locationsNorth Fulton Hospital time typePart time posted onPosted 2 Days Ago job requisition idJR-73995 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Job Summary: The LPN works under the direction of the direction of a Registered Nurse or Nurse Manager and functions within the LPN Scope of Practice. Provides care for the patient. This includes age appropriate interventions that meet physical, emotional, developmental, psychosocial and educational needs. The LPN is...