Talent.com
RN Licensed Utilization Management Director
RN Licensed Utilization Management DirectorVirtualVocations • Dorchester, Massachusetts, United States
RN Licensed Utilization Management Director

RN Licensed Utilization Management Director

VirtualVocations • Dorchester, Massachusetts, United States
30+ days ago
Job type
  • Full-time
Job description

A company is looking for a Director, Utilization Management Support Operations.

Key Responsibilities

Directs the utilization management team to ensure compliance with policies and procedures for optimal member outcomes

Reviews and analyzes utilization trends to enhance the effectiveness of the utilization program

Provides strategic leadership for the Peer-to-Peer Call Center, ensuring timely communication and operational efficiency

Required Qualifications

Bachelor's degree required

7+ years of related experience, including prior management experience

4+ years of management experience preferred

Expert knowledge of industry regulations and standards preferred

Healthcare background in a call center environment is highly preferred

Create a job alert for this search

Rn Utilization Management • Dorchester, Massachusetts, United States

Related jobs
Travel - X-Ray Tech

Travel - X-Ray Tech

Titan Medical Group • Greenbush, MA, US
Full-time
WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country. You also get unmatched service.From the moment y...Show more
Last updated: 1 day ago • Promoted
Travel Nurse RN - ER

Travel Nurse RN - ER

Titan Medical Group • Gloucester, MA, US
Full-time
WHEN YOU WORK FOR US, WE WORK FOR YOU\n.With Titan Medical, you gain access to thousands of travel nursing and allied health jobs across the country. You also get unmatched service.From the moment y...Show more
Last updated: 1 day ago • Promoted
Build a New Future with Free CDL Training - Must Have Criminal History

Build a New Future with Free CDL Training - Must Have Criminal History

Emerge • Cohasset, MA, US
Full-time
We are a government-funded job training program for people who have been impacted by the justice system (arrest, probation, parole, or incarceration), and we help them become CDL truck drivers.Free...Show more
Last updated: 3 days ago • Promoted
Minnesota Licensed Utilization Review Nurse

Minnesota Licensed Utilization Review Nurse

VirtualVocations • Dorchester, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Nurse responsible for managing pre-claim prior authorization denials for pharmacy and medical benefits. Key Responsibilities Review and assess prior a...Show more
Last updated: 3 days ago • Promoted
Tennessee RN Utilization Review

Tennessee RN Utilization Review

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for an RN Utilization Review.Key Responsibilities Perform clinical assessments and evaluate injured employees' treatment utilization and compliance Collaborate with healthca...Show more
Last updated: 5 days ago • Promoted
Manager - Utilization Review & Denials Management

Manager - Utilization Review & Denials Management

Beth Israel Lahey Health • Plymouth, MA, US
Full-time
Utilization Review & Denials Management Manager - Full Time.When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.Full Time Job Description...Show more
Last updated: 30+ days ago • Promoted
Licensed Utilization Review Clinician

Licensed Utilization Review Clinician

VirtualVocations • Dorchester, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Clinician - ABA.Key Responsibilities Evaluates member's care and health status related to Applied Behavioral Analysis (ABA) services to ensure medica...Show more
Last updated: 30+ days ago • Promoted
DC Licensed Utilization Nurse Reviewer

DC Licensed Utilization Nurse Reviewer

VirtualVocations • Dorchester, Massachusetts, United States
Full-time
A company is looking for a Utilization Nurse Reviewer (Remote).Key Responsibilities Conduct timely clinical chart reviews and communicate effectively with third-party payers Review admission ser...Show more
Last updated: 4 days ago • Promoted
Free Truck-Driver Training & Job Coaching – Must Have Criminal History

Free Truck-Driver Training & Job Coaching – Must Have Criminal History

Emerge • Cohasset, MA, US
Full-time
We are a government-funded job training program for people who have been impacted by the justice system (arrest, probation, parole, or incarceration), and we help them become CDL truck drivers.Free...Show more
Last updated: 3 days ago • Promoted
California Licensed Utilization Management Nurse

California Licensed Utilization Management Nurse

VirtualVocations • Dorchester, Massachusetts, United States
Full-time
A company is looking for a Utilization Management Nurse - LVN (Work from Home).Key Responsibilities Perform medical necessity reviews for assigned members Collaborate with the Medical Director o...Show more
Last updated: 24 days ago • Promoted
Tennessee Licensed Utilization Review Clinician

Tennessee Licensed Utilization Review Clinician

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Clinician - Behavioral Health.Key Responsibilities Evaluate member's treatment for mental health and substance abuse to ensure medical appropriatenes...Show more
Last updated: 5 days ago • Promoted
RN Licensed Utilization Management Director

RN Licensed Utilization Management Director

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for a Director, Utilization Management Support Operations.Key Responsibilities Directs the utilization management team to ensure compliance with policies and procedures for o...Show more
Last updated: 30+ days ago • Promoted
Ohio Licensed Utilization Management RN

Ohio Licensed Utilization Management RN

VirtualVocations • Dorchester, Massachusetts, United States
Full-time
A company is looking for a Utilization Management RN Reviewer.Key Responsibilities Conduct admission, concurrent, and retrospective reviews of patient charts and clinical systems Collaborate wit...Show more
Last updated: 4 days ago • Promoted
Ohio Licensed Utilization Management Nurse

Ohio Licensed Utilization Management Nurse

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for a Utilization Management Nurse Consultant.Key Responsibilities Assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members Gather clinical...Show more
Last updated: 30+ days ago • Promoted
Maine Licensed Utilization Review Nurse

Maine Licensed Utilization Review Nurse

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Nurse - Remote.Key Responsibilities Review prior authorization requests for medical necessity and manage medical claims disputes Coordinate transiti...Show more
Last updated: 30+ days ago • Promoted
Hawaii Licensed Utilization Review Clinician

Hawaii Licensed Utilization Review Clinician

VirtualVocations • Lowell, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Clinician - Behavioral Health.Key Responsibilities Evaluates treatment for mental health and substance abuse to ensure medical appropriateness Perfo...Show more
Last updated: 3 days ago • Promoted
Center Director - BCBA

Center Director - BCBA

HealthPRO Pediatrics • Plymouth, MA, US
Full-time
If you're looking for a new place for your career to thrive and continue your professional growth, I have just the thing for you! Great full-time. ABA and outpatient, peds clinic in Plymouth, MA...Show more
Last updated: 20 days ago • Promoted
Free CDL Program & Job Placement - Must Have Criminal History

Free CDL Program & Job Placement - Must Have Criminal History

Emerge • Cohasset, MA, US
Full-time
We are a government-funded job training program for people who have been impacted by the justice system (arrest, probation, parole, or incarceration), and we help them become CDL truck drivers.Free...Show more
Last updated: 4 days ago • Promoted