utilization management manager

Brighton Health Plan Solutions

<div>
 
 About The Role
 
 
 
 BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member&rsquo;s benefit coverage while working remotely.
 
 
 
 Primary Responsibilities
 
 
 
 <ul>
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 Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures
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 Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments
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 Collaborates with healthcare partners to ensure timely review of services and care
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 Provides referrals to Case management, Disease Management, Appeals &amp; Grievances, and Quality Departments as needed
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 Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
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 Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate
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 Triages and prioritizes cases and other assigned duties to meet required turnaround times
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 Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations
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 Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements
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 Duties as assigned
 
 
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 </ul>
 
 Essential Qualifications
 
 
 
 <ul>
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 Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment
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 Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
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 Must be able to work independently
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 Must be detail oriented and have strong organizational and time management skills
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 Adaptive to a high pace and changing environment- flexibility in assignment
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 Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review
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 Proficient in MCG and CMS criteria sets
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 Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred
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 Working knowledge of URAC and NCQA
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 2+ years&rsquo; experience in a UM team within managed care setting
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 3+ years&rsquo; experience in clinical nurse setting preferred
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 TPA Experience preferred
 
 
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 </ul>
 
 About
 
 
 
 At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you&rsquo;ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you&rsquo;ll be encouraged to bring your authentic self to work with all of your unique abilities.
 
 
 Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today&rsquo;s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today&rsquo;s challenges into tomorrow&rsquo;s solutions.
 
 
 Come be a part of the Brightest Ideas in Healthcare&trade;.
 
 
 
 Company Mission
 
 
 
 Transform the health plan experience &ndash; how health care is accessed and delivered &ndash; by bringing outstanding products and services to our partners.
 
 
 
 Company Vision
 
 
 
 Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
 
 
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</div>

Utilization Management Nurse

Listgrove Ltd

<div>
 
 The Operations Manager is responsible for multiple production facilities, covering a daily throughput of approximately 4,000 MT material &ndash; metal and non-metals. The role covers inbound receiving, processing, and outbound shipping, and carries accountability for how each stage is organized, performed, and continuously improved across all sites. The role is built on 3 operational disciplines of equal importance. Standardization, Efficiency, and Capacity Utilization.
 
 
 This is a field-based role that requires regular personal presence across all facilities. The quality of operations at this scale is best assessed and improved through direct supervision and engagement, not through remote reporting. The right candidate brings the technical depth to assess what they see, the interpersonal credibility to influence how teams work, and the leadership maturity to drive sustained improvement across a complex, multi-site network.
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 
 
 Team Leadership
 
 
 
 The Operations Manager leads Processing Team Leaders and their teams of processing supervisors across all sites. Building capable, accountable, and improvement-oriented teams at every level is a defining and continuous dimension of the role.
 
 
 
 
 
 
 Standardization
 
 
 
 A consistent standard operating model is the foundation on which efficiency and capacity utilization are built. Without clearly defined and enforced standards across all yards, each site tends toward its own working practices, and inconsistency at scale is where operational performance is lost before it can be measured or improved.
 
 
 
 
 
 
 Efficiency
 
 
 
 Operational efficiency is the measure of how material moves through each stage of the cycle, from receiving at the gate to dispatch from the yard. Unnecessary handling steps, avoidable delays, poor staging decisions, and rework at any stage reduce the value of the work performed without contributing to output. The Operations Manager is responsible for identifying these losses systematically and eliminating them from the operational model across both streams and all yards.
 
 
 
 
 
 
 Capacity Utilization
 
 
 
 Capacity Utilization measures how much of the available capacity, in equipment, machinery labors, and transportation, is being productively used. Closing the gap between what the assets can produce and what they actually produce through operational planning, scheduling discipline, and resource deployment management is a central accountability of this role.
 
 
 
 
 
 
 Commercial Interface
 
 
 
 The Operations Manager serves as the primary link between the operational network and the commercial team through 2 way effective communication that translates commercial demand into operational planning, while feeding operational performance and capacity data back into commercial decision-making.
 
 
 
 
 
 
 Safety Compliance
 
 
 
 The Operations Manager ensures that all operational activities across the receiving, processing, and shipping cycle comply fully with applicable safety standards, and that safe working requirements are embedded as an integral part of the standard operating model at every stage.
 
 
 
 
 
 
 Education, Skills &amp; Experience
 
 
 
 
 
 
 
 Education
 
 
 
 A recognised qualification + proven experience is a key requirement.
 
 
 
 
 
 
 Experience
 
 
 
 10 years or more in a senior operations management in a bulk material processing, heavy manufacturing, or commodity handling environment.
 
 
 
 
 
 
 Technical Knowledge
 
 
 
 Working knowledge of bulk material processing equipment to assess utilization, identify workflow inefficiencies, and engage productively with maintenance and equipment teams. Familiarity with shift scheduling design as a tool for improving equipment and labor utilization across a multi-site network. Understanding of OEE principles and their application in an industrial processing environment. Experience with ERP or operational management platforms for production scheduling, capacity planning, and performance monitoring. Practical application of Lean, Six Sigma, or equivalent continuous improvement methodologies across multiple sites, with demonstrated impact on efficiency or utilization outcomes. Experience with multi-modal outbound logistics, truck, and container, with demonstrated improvement in load utilization across a dispersed network. Familiarity with commodity trading dynamics and the relationship between operational decisions and their commercial implications.
 
</div>

Group Operations Manager

Gila River Health Care

<div>Summary :
The Case Manager will provide comprehensive Case Management for patients as assigned to include, but not limited to: assessing patient&rsquo;s needs; developing, implementing, monitoring, and documenting the progress of the patient throughout their hospitalization in an outside area hospital to meet their care needs prior to discharge. The intensity of Case Management is situational and appropriately based on patient need. This position is accountable for the quality of clinical services provided by both them and others and identifies barriers which may hinder effective patient care. The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing patient admissions and continued stay criteria to identify issues that may delay patient discharge and facilitate resolution of these issues. 
 
Critical Tasks:
<ul><li>Demonstrates a culture of kindness through all interactions whether verbal or non-verbal with all GRHC staff members, partner facilities staff and vendors.
</li></ul><ul><li>Manages and oversees assigned patient case load to ensure delivery of all covered services identified for continuity of care across all levels of care and involved providers to achieve the optimal clinical, financial, operational, and patient satisfaction outcomes.
</li></ul><ul><li>Maintains HIPAA standards of patient confidentiality during all interactions whether written, verbal, or electronic.
</li></ul><ul><li>Establishes and promotes a collaborative relationship with members of the healthcare team within GRHC and outside facility partners.
</li></ul><ul><li>Serves as Case Manager between referral hospitals, treatment facilities and patients/patient&rsquo;s families to ensure delivery of effective and appropriate assistance and follow-up for returning to pre/post hospitalization status/care.
</li></ul><ul><li>Reviews charts of assigned patients to determine appropriate referral services based on assessed patient needs.
</li></ul><ul><li>Facilitates, schedules and/or participates in a variety of patient Case Management activities to ensure patient and/or family personal and health care needs are met in a timely manner; proactively identifies alternative resources as needed.
</li></ul><ul><li>Participates in &ldquo;on-call&rdquo; for Case Management Department and Utilization Review
</li></ul><ul><li>Performs Utilization Review of patient chart to ensure compliance with established InterQual criteria to maximize reimbursement/coverage of charges.
</li></ul><ul><li>Evaluates inpatient medical necessity and appropriateness of care utilizing InterQual criteria, for optimizing outcomes.
</li></ul><ul><li>Assesses patient admissions and continued stay to identify issues that may delay patient discharge and communicates to the interdisciplinary team while facilitating a resolution.
</li></ul><ul><li>Collects and communicates pertinent, timely information to the health care team to fulfill utilization and regulatory requirements.
</li></ul><ul><li>Collaborates with patient, family members, and other involved parties to ensure care coverage through private and governmental health care plans.
</li></ul><ul><li>Collects outcome data to be used in identifying best practices and targeting performance improvement solutions.
</li></ul><ul><li>Participates in departmental orientation, on the job training, and quality assurance programs/initiatives.
</li></ul><ul><li>Receives and responds to patient concerns; research issues for corrective action as appropriate based on findings; escalates physician/provider concerns to appropriate parties and identifies alternative solutions.
</li></ul><ul><li>Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
</li></ul><ul><li>Participates in Community Events representing GRHC and Case Management Department with ability to educate on departmental functions.
</li></ul><ul><li>Other duties as assigned by Case Management Director/Manager
</li></ul><ul><li>Establishes goals and objectives for the department that meet or exceed GRHC&rsquo;s Code of Ethics and Standards for Conduct Policy.
</li></ul><ul><li>Is familiar and remains current on safety and emergency management process for the department.
</li></ul>Required Qualifications:
<ul><li>Current State of Arizona or Compact State Registered Nurse license, BSN preferred.
</li></ul><ul><li>Current CPR for Healthcare professional's certification
</li></ul><ul><li>Must have at least 1-year previous case management experience, CCM certification preferred but must obtain within 2 years of hire.
</li></ul><ul><li>Experience must include working in an acute care and/or home care setting for at least a 12-month period.
</li></ul><ul><li>Native American population preferred.
</li></ul><ul><li>Must have a working knowledge of Case Management, acute care and/or home care environments, community resources and resource/utilization management.
</li></ul><ul><li>Case Management Specialty Area Requirements :
<ul><li>Pediatrics Case Manager &ndash; Must have at least 1 year Pediatrics experience
</li><li>Cancer Case Manager &ndash; Must have at least 1 year oncology/hospice/or cancer case management experience
</li><li>Pain Management Case Manager &ndash; Must have at least 1 year experience working with pain management patients/hospice patients .
</li><li>Women&rsquo;s Health/High Risk Pregnancy Case Manager &ndash; Must have at least 1 year Women&rsquo;s Health/Pregnancy experience
</li><li>Family Medicine Case Manager &ndash; Must have at least 1 year Medical-Surgical or Family Clinic experience
</li><li>Internal Medicine Case Manager - Must have at least 1 year Medical-Surgical or Family Clinic experience
</li><li>Emergency Department/Utilization Review Case Manager &ndash; Must have 1 year Medical-Surgical experience and/or 1 year Utilization Review experience</li></ul></li></ul></div>

Case Manager-Case Management-HHK-Sacaton

Anwar Khawaja Industries Pvt. Limited

Job PurposeThe Manager Operations is responsible for planning, coordinating, and supervising daily operational activities to ensure efficient production, optimum resource utilization, quality compliance, and timely delivery of products in line with organizational objectives.Key Responsibilities1. Operational Management<ul><li>Oversee overall operations including production, planning, logistics, and workflow management. Liason with manufacturing units.</li><li>Ensure smooth execution of daily operational activities.</li><li>Develop and implement operational strategies to improve productivity and efficiency.</li><li>Monitor operational performance against KPIs and targets.</li></ul>2. Production Planning &amp; Control<ul><li>Coordinate with production teams to achieve production targets.</li><li>Ensure optimum utilization of manpower, machines, and materials.</li><li>Monitor production schedules and resolve operational bottlenecks.</li><li>Ensure on-time order completion and delivery commitments.</li></ul>3. Process Improvement<ul><li>Identify process inefficiencies and implement continuous improvement initiatives.</li><li>Introduce cost-saving and productivity enhancement measures.</li><li>Implement Lean Manufacturing / Operational Excellence practices.</li></ul>4. Quality &amp; Compliance<ul><li>Ensure compliance with company quality standards and customer requirements.</li><li>Coordinate with Quality Assurance for defect reduction and process control.</li><li>Maintain compliance with safety, environmental, and regulatory standards.</li></ul>5. Team Management<ul><li>Supervise department heads, supervisors, and operational staff.</li><li>Develop workforce capability through training and performance management.</li><li>Conduct performance reviews and ensure discipline and accountability.</li></ul>6. Coordination &amp; Communication<ul><li>Liaise with Sales, Planning, Procurement, HR, and Finance departments.</li><li>Coordinate customer requirements with operational execution.</li><li>Prepare operational reports for management review.</li></ul>7. Cost &amp; Resource Management<ul><li>Monitor operational costs and control wastage.</li><li>Improve efficiency in material consumption and labor utilization.</li><li>Support budgeting and cost optimization initiatives.</li></ul>8. Health, Safety &amp; Workplace Management<ul><li>Ensure implementation of health &amp; safety policies.</li><li>Promote safe working environment across all operational areas.</li><li>Conduct risk assessments and corrective actions.</li></ul>Key Performance Indicators (KPIs)<ul><li>Production efficiency</li><li>On-time delivery performance</li><li>Cost reduction achievement</li><li>Quality rejection rate</li><li>Machine utilization</li><li>Workforce productivity</li><li>Safety compliance</li></ul>Qualification &amp; Experience<ul><li>Bachelor&rsquo;s degree in Engineering / Industrial Management / Business Administration (Master&rsquo;s preferred).</li><li>7&ndash;10 years of relevant experience in operations or production management.</li><li>Strong leadership and problem-solving skills.</li><li>Experience in manufacturing environment preferred.</li></ul>Job Type: Full-timeWork Location: In person

Manager Operations

Talent 360

<div>United Elevators is seeking an experienced Warehouses Manager to oversee and optimize warehouse operations.
Job Responsibilities include but are not limited to:<ul><li>
Manage and improve all warehouse operations, ensuring high inventory accuracy and efficient storage capacity utilization.</li><li>
Oversee timely fulfillment and dispatch of orders, monitoring order cycle times and mean time to reach per item category.</li><li>
Ensure warehouse safety and maintain a low safety incident rate.</li><li>
Implement best practices to optimize warehouse layout, storage capacity, and overall utilization.</li><li>
Lead, mentor, and manage warehouse staff, promoting strong organizational practices and effective decision-making.</li><li>
Monitor warehouse performance continuously and implement corrective actions as needed.</li></ul>
Qualifications:<ul><li>
Bachelor&rsquo;s degree in Supply Chain Management or a related field.</li><li>
8+ years of warehouse management experience, preferably in industrial or construction environments.</li><li>
Strong knowledge of Warehouse Management Systems (WMS).</li><li>
Excellent leadership, decision-making, and problem-solving skills.</li><li>
Proficient in Microsoft Office and other professional software.</li></ul>
Working Conditions:<ul><li>
Working Hours: From 9:00 AM to 6:00 PM</li><li>
Fridays &amp; Saturdays are off</li><li>
Main Location: Badr City</li><li>
Secondary Work Location: New Cairo</li></ul>
Company Website: http://www.unitedelevators.net/</div>

Warehouses Manager - Badr & New Cairo

TEEMA

<div><ul><li>13 week contract</li><li>
REQUIRED: 5+ years case management experience with 2+ years recent acute inpatient case management experience</li><li>
BSN or MSW, Current MI RN licensure or LMSW, Discharge planning experience.</li><li>
There will be limited training on site - candidates will need to be able to adapt quickly.</li><li>
Manager will be reaching out to candidates directly for interview</li><li>
MANAGER IS VERY STRICT ON THE RECENT INPATIENT CASE MANAGEMENT EXPERIENCE - TELEPHONIC, UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.</li></ul> 

#Workwolf</div>

Case Manager

SANCTUARY

Overview We are seeking a dedicated and compassionate Case Manager to join our dynamic healthcare team. In this vital role, you will coordinate patient care plans, facilitate communication among multidisciplinary teams, and ensure seamless discharge planning and utilization management. Your expertise will help optimize patient outcomes, improve hospital efficiency, and support patients through complex medical journeys. This position offers an exciting opportunity to make a meaningful impact in a fast-paced, patient-centered environment.Responsibilities<ul><li>Assess patient needs through comprehensive intake and evaluation processes, including medical terminology review and social work considerations. </li><li>Develop personalized care plans that incorporate critical care experience, hospital experience, and behavioral health insights. </li><li>Coordinate with healthcare providers across specialties such as ICU, emergency medicine, pediatrics, and trauma centers to facilitate appropriate care delivery. </li><li>Manage discharge planning by collaborating with patients, families, and interdisciplinary teams to ensure smooth transitions from hospital to home or other care settings. </li><li>Conduct utilization review and utilization management activities to ensure compliance with healthcare policies like HIPAA and managed care standards. </li><li>Document all case management activities accurately within EMR (Electronic Medical Records) and EHR (Electronic Health Records) systems while maintaining confidentiality. </li><li>Support patients through complex medical processes such as CPT coding, ICD-9/10 coding, and medical terminology interpretation for billing and documentation purposes.</li></ul>Skills<ul><li>Proven experience in critical care, hospital medicine, or emergency medicine settings with a strong understanding of ICU, PICU, or Level I/II trauma center operations. </li><li>Expertise in discharge planning, intake procedures, utilization review, and managed care protocols. </li><li>Familiarity with EMR/EHR systems, HIPAA regulations, and medical coding including ICD-10/ICD-9/ CPT coding standards. </li><li>Knowledge of hospice care principles, behavioral health practices, and social work strategies to support diverse patient populations. </li><li>Strong communication skills to collaborate effectively with multidisciplinary teams across acute care environments. </li><li>Ability to navigate complex medical terminology and documentation requirements efficiently. </li><li>Experience working in high-pressure environments such as Level I trauma centers or Level II trauma centers with OR experience preferred. Join us in delivering exceptional patient-centered care by leveraging your clinical expertise and passion for helping others!</li></ul>Pay: $19.00 - $22.00 per hourWork Location: In person

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10000 utilization management manager jobs Near Me

Utilization Management Nurse

Group Operations Manager

Case Manager-Case Management-HHK-Sacaton

Manager Operations

Warehouses Manager - Badr & New Cairo

Case Manager

Case Manager