Jobs in the United States

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Added just now
Assembly Supervisor
ASSA ABLOY
Phoenix, AZ
…operations. Reporting directly to the Technical Operations Manager, you will be the primary point of contact for the team, driving quality, efficiency, and on-time delivery of our…
Added just now
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Store Associate
CVS Health
Walterboro, SC
- $15 to $18 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
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CH
Pharmacy Manager
CVS Health
Tucson, AZ
- $65 to $85 USD / hour
…helping manage chronic and specialty conditions. As Pharmacy Manager, you have one of the most significant roles in our company ΓÇô delivering our purpose, modeling our values, and…
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Store Associate
CVS Health
Dearborn Heights, MI
- $15 to $19 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
Added just now
CH
Store Associate
CVS Health
Galveston, TX
- $15 to $19 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
Added just now
CH
Store Associate
CVS Health
Sulphur, LA
- $15 to $18 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
Added just now
CH
Store Associate
CVS Health
Austin, TX
- $15 to $18 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
Added just now
CH
Operations Manager
CVS Health
Pflugerville, TX
- $18 to $28 USD / hour
Unlike the Store Manager in Training position, the Operations Manager position is not part of the CVS/pharmacy Retail Management Development Program. Operations Managers are not eligible…
Added just now
CH
Store Associate
CVS Health
Dallas, TX
- $15 to $19 USD / hour
Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
Added just now
CH
Operations Manager
CVS Health
Dallas, TX
- $19 to $29 USD / hour
Unlike the Store Manager in Training position, the Operations Manager position is not part of the CVS/pharmacy Retail Management Development Program. Operations Managers are not eligible…
Added just now
CH
Operations Manager
CVS Health
Rockwall, TX
- $19 to $29 USD / hour
Unlike the Store Manager in Training position, the Operations Manager position is not part of the CVS/pharmacy Retail Management Development Program. Operations Managers are not eligible…
Added just now
A
Senior Manager, IT SOX Compliance
Adobe
San Jose, CA · San Francisco, CA
- $225,300 USD / year
Adobe’s Risk Advisory & Assurance Services (RAAS) team is seeking a Senior Manager to lead our IT SOX compliance program and ensure the technology controls supporting financial reporting…
Added 1 min ago
Transportation Manager
US Foods, Inc.
Fairburn, GA
We’re excited about your interest in pursuing the next step in your career with US Foods! Your continuous growth and development is critical to our success.
Added 1 min ago
Night Warehouse Manager - $8,000 Sign-On
US Foods, Inc.
Salem, VA
On day shift, designate dock locations for inbound carriers
Added 1 min ago
District Sales Manager
US Foods, Inc.
Plymouth, MN
Must have proficient computer skills, preferably in Microsoft Office products (e.g., Word, Excel, PowerPoint, Outlook) · Valid driver's license required
Added 1 min ago
Day Warehouse Manager
US Foods, Inc.
Alcoa, TN
On day shift, designate dock locations for inbound carriers
Added 1 min ago
Territory Manager - Idaho Falls
US Foods, Inc.
Idaho Falls, ID
We’re excited about your interest in pursuing the next step in your career with US Foods! Your continuous growth and development is critical to our success.
Added 1 min ago
Facility Maintenance Manager
US Foods, Inc.
Alcoa, TN · Knoxville, TN
We’re excited about your interest in pursuing the next step in your career with US Foods! Your continuous growth and development is critical to our success.
Added 1 min ago
Lead Engineering Tech II
Aerospace
Phoenix, AZ
YOU MUST HAVE
Added 1 min ago
NG
Sr. Manager: Production Services & Partnership Operations (Nat Geo)
National Geographic Partners PAY SVC
Washington, DC
- $106,600 to $143,000 USD / year
The Senior Manager, Production Services & Partnership Operations serves as the dedicated operational and production lead for the Rolex partnership, providing accountability, and oversight…
Added 1 min ago
DO
Licensing-Registration Examiner
Department of Motor Vehicles
CA
- $4,810 to $5,899 USD / month
Additionally, applicants must have authorization to work in the United States
Added 1 min ago
DO
Network Manager – Telework Hybrid
Department of Motor Vehicles
CA
- $9,387 to $12,579 USD / month
Additionally, applicants must have authorization to work in the United States
Added 1 min ago
CC
C.E.A. (Level C), Deputy Director of Dispute Resolution
California Civil Rights Department
United States
- $10,349 to $21,370 USD / month
All applicants must possess the knowledge and abilities, and any other requirements, described in this announcement · State civil service employees must possess essential general qualifications including integrity, initiative, dependability, good judgment,
Added 1 min ago
Designer, Collateral & Events
IPSY
United States
…monthly virtual activities, company-wide offsites, professional development, and learning sessions, to help our team members stay connected, engaged, and impactful while working…
Added 2 mins ago
Senior System Administrator
Trideum Corporation
Huntsville, AL
Manage, configure, and maintain Windows and Linux-based systems across development, integration, and test environments.

CareSource Management Services LLC

Manager, Utilization Management

Remote, United States

Apply on caresource.wd1.myworkdayjobs.com About employer

Applications open in a new tab.

Job details

Pay: $83,000.00 - $132,800.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level.
Posting language: English
Posted: Nov 10, 2026

Original job description

Job Summary:

The Manager, Utilization Management is responsible for the oversight of all utilization management activities ensuring consistency of services and achievement of utilization targets.

Essential Functions:

Assist in coordination and management of the pre-determination process of medical and dental services; ensure the consistent application of criteria for authorization decision, and that decisions to deny or reduce services are made by a health care professional who has appropriate clinical expertise
Assist in the development of integrated service delivery to members and oversee utilization management data and processes to maintain industry standards and practices including decisions within allowable timeframes
Interact with providers and staff to manage benefits aligned with state-based regulations, NCQA and/or URAC regulations, and CareSource policies
Review and revise workflows to maximize efficiencies
Monitor productivity and utilization trends
Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
Regularly report all utilization management regulatory requirements
Ensure compliance with and reporting of all regulatory requirements
Maintain all utilization management reporting and trend data
Analyze under and over utilization information for impact on member quality of care and outcomes and formulate recommendations based on data
Develop, maintain and update all departmental policies and procedures; ensure notices of adverse action are provided in accordance with required regulations
Audit predetermination requests, cases for documentation and interrater reliability per CareSource policy
Act as liaison with other departments to assist with research and intervention
Perform any other job related instructions, as requested

Education and Experience:

Associate’s Degree in Nursing is required and Bachelors of Science in Nursing (BSN) is preferred
Minimum of five (5) years of clinical experience is required
Minimum of five (5) years of experience in one of the following is required: case management, utilization management, and/or quality improvement
Two years of utilization management experience is preferred
Managed care experience is preferred

Competencies, Knowledge and Skills:

Beginning Excel, Word and PowerPoint experience
Experience in data analysis and trending
Knowledge of utilization management standards and practices
Communication skills
Management and prior supervisory skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the health care field
Critical listening and thinking skills
Training/teaching skills
Strategic management skills
Negotiation skills/experience
Proper grammar usage
Change resiliency
Technical writing skills
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving skills
Leadership experience and skills

Licensure and Certification:

Current, unrestricted licensure in state of practice as a Registered Nurse (RN) is required

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$83,000.00 - $132,800.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary Organization Level Competencies

Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Brand=CareSource

Apply on caresource.wd1.myworkdayjobs.com About employer

More about this job

Skills

Regulatory compliance
Reporting
Documentation
Research
Case management
Microsoft Excel
Microsoft Word
Microsoft PowerPoint
Data analysis
Communication skills
Work independently
Attention to detail
Teaching
Negotiation
Technical writing
Time management
Customer service
Decision making
Problem solving
Leadership
RN

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Work requirements

Jobs in the United States