Jobs in the United States

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Added 15 mins ago
Administrative Assistant II - SHN
Idaho Division of Human Resources
Orofino, ID
Good knowledge of office support functions including word processing, filing, composing a variety of business documents and reception. Typically gained by at least one year of work…
Added 15 mins ago
Dry Etch Process Manager
Micron Technology, Inc.
Boise, ID
As a world leader in the semiconductor industry, Micron is dedicated to your personal wellbeing and professional growth. Micron benefits are designed to help you stay well, provide peace of…
Added 15 mins ago
Strategy & Operations Manager (IC)
CVS Health
Boise, ID
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Added 15 mins ago
IT Field Service Technician
Micron Technology, Inc.
Boise, ID
As a world leader in the semiconductor industry, Micron is dedicated to your personal wellbeing and professional growth. Micron benefits are designed to help you stay well, provide peace of…
Added 15 mins ago
IT Field Service Technician
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Boise, ID
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Added 15 mins ago
INSPECTIONS SPECIALIST (SUPERINTENDENT)
Air National Guard Units
Boise, ID
…SPECIALIST (SUPERINTENDENT), Position Description Number D2897000 and is part of the ID 124 Wing, National Guard. THIS POSITION IS INDEFINITE (NOT TO EXCEED 5 YEARS) AND MAY…
Added 15 mins ago
Care Manager, Telephonic Nurse
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Pharmacy Technician Central Fulfillment
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Current knowledge of state and federal regulations and statutes regarding the practice of pharmacy and the distribution of approved drugs, controlled substances, and investigational agents.
Added 15 mins ago
Program Manager, College and Career Readiness
Idaho Division of Human Resources
Boise, ID
The College and Career Readiness Program Manager provides leadership and coordination for initiatives that help Idaho students prepare for postsecondary education and careers. The position…
Added 15 mins ago
Pharmacy Technician Specialty Pharmacy
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Current knowledge of state and federal regulations and statutes regarding the practice of pharmacy and the distribution of approved drugs, controlled substances, and investigational agents.
Added 15 mins ago
Project Manager 1 - CYFS
Idaho Division of Human Resources
Boise, ID
This position offers the opportunity to contribute to meaningful system improvements that protect and strengthen Idaho's families and children. Through supporting projects that improve…
Added 16 mins ago
Sr Manager - Proj/Prog
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Boise, ID
The Sr. Manager provides overall leadership and management for assigned federal contact center programs and serves as the primary management focal point responsible for the administrative,…
Added 16 mins ago
Pharmacy Technician Refill Authorization
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Current knowledge of state and federal regulations and statutes regarding the practice of pharmacy and the distribution of approved drugs, controlled substances, and investigational agents.
Added 16 mins ago
Anesthesia Tech
Trinity Health
Boise, ID
…center under the direct supervision of the anesthesiologist and manager. The Anesthesia Technician assists the anesthesia team prior to, during, and following patient procedures in various…
Added 16 mins ago
Licensing Associate - Agricultural Resources
Idaho Division of Human Resources
Boise, ID
Partner with IT and the Program Manager to define systems needs, assist in building business requirements, troubleshooting bugs, and test improvements.
Added 16 mins ago
Product Marketing Manager
Meta
Boise, ID
Meta is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy,…
Added 16 mins ago
Manager, Subcontracts
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Remote, United States
The Manager, Subcontracts will lead and develop a team of subcontract professionals supporting complex defense and aerospace programs. This position oversees the entire subcontract…
Added 17 mins ago
Sr. Manager, Program Performance Operational Excellence (Onsite)
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The Sr. Manager, Performance Operational Excellence, Strategic Military Development, will play a critical role in driving organizational efficiency and ensuring the successful execution of…
Added 20 mins ago
Care Manager, Telephonic Nurse
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As a Care Manager, Telephonic Nurse , you will report directly to the Manager, Care Management. You will help to ensure optimal continuity of care for patients transitioning into and out of…
Added 20 mins ago
Sr Manager - Proj/Prog
Maximus
Lincoln, NE
The Sr. Manager provides overall leadership and management for assigned federal contact center programs and serves as the primary management focal point responsible for the administrative,…
Added 20 mins ago
Product Marketing Manager
Meta
Lincoln, NE
Meta is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy,…
Added 31 mins ago
G
Appeals & Grievances Coordinator
GuideWell
FL
- $20 to $33 USD / hour
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal…
Added 44 mins ago
EPC Automation Lead
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Participates in the rollout of new technologies, services, and security remediations by working with the GBU Innovation Manager, AI Program Manager, and Bechtel Equipment Operations.
Added 45 mins ago
PR
Assistant Manager (P1-1357564-9)
Panda Restaurant Group
Buffalo Grove, IL
- $22.5 to $25.5 USD / hour
You are in charge of assisting the operation of a single store. This includes, but is not limited to, hiring, managing and directing of associates to achieve financial goals and ensuring…
Added 45 mins ago
PR
Assistant Manager (P1-1357550-10)
Panda Restaurant Group
Chicago, IL
- $15 to $40 USD / hour
You are in charge of assisting the operation of a single store. This includes, but is not limited to, hiring, managing and directing of associates to achieve financial goals and ensuring…

COMMUNITY HEALTH GROUP

Manager - Utilization Management Manager

Chula Vista, CA, United States

$121,237.49 to $145,484.98 USD / year

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Job details

Pay: $121,237.49 to $145,484.98 USD / year
Experience: 3 years of clinical nursing; 2 years of UM/UR experience
Posting language: English
Posted: Nov 3, 2026

Original job description

POSITION SUMMARY:

The Utilization Management Manager orients, guides and oversees the Inpatient, Outpatient case managers, transition of care coordinator, Health Home Program (HHP), and Inpatient support staff. The role is to plan, develop, implement, evaluate and refine case management intervention. This individual supervises the case management and concurrent review personnel and ensures that they assess, plan and deliver care appropriate to the age specifics of every member and all others involved within the job structure.

COMPLIANCE WITH REGULATIONS

Works closely with all departments necessary to ensure that the processes, programs, and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D and Special Needs Plan (SNP).

RESPONSIBILITIES

Supervises the case managers and concurrent review nurses in the performance of their role and position description.
Assists the case managers in the coordination of care and service of a selected client population across the continuum of illness.
Formulates, implements, and evaluates the knowledge base of the case managers and concurrent review nurses in the performance of their position description.
Analyzes the case management goals for the members, reviews the plan for its appropriateness, and reviews and identifies anticipated outcomes.
Develops and maintains a positive work climate that supports the overall staff efforts at CHG.
Assists in developing the philosophy, goals, and objectives for concurrent case management performance that meets clinical and financial requirements.
Anticipates, recommends, implements, and evaluates policies and procedures related to case management and concurrent review.
Contributes to the organization’s goals and objectives; supports the organizational strategic plan.
Actively participates in the development of clinician guidelines and incorporates the process into the role of the case managers.
Interfaces with external agencies and provides appropriate information, consultation, and recommendations.
Supports the culture of continuous quality improvement.
Uses quality improvement tools and strategies in problem-solving activities.
Identifies patterns or trends in case management that have or had the potential for adverse impact on member interventions.
Develops corrective action plans and reevaluation of outcomes.
Attends educational and training programs to expand knowledge.
Prepares all regulatory reports in a timely manner.
Attends all committee meetings along with ensuring meeting minutes are correct and detailed.
Works on all assigned projects as requested. All other duties as assigned.

Qualifications

EDUCATION

BS in Nursing
Masters in Nursing preferred.
Foreign medical graduates, health education, or another mental/social health discipline (a combination of experience and education will be considered in lieu of a degree in nursing).

•

EXPERIENCE/SKILLS

3 years of clinical nursing; 2 years of UM/UR experience
2 years of experience in managed care is preferred.
CPT and ICD10-CM coding; M&R and/or other UM criteria; Microsoft Office software or equivalent; knowledge of applicable state and federal laws and NCQA; working knowledge of Medicaid, CCS required.
Experience in interpreting Utilization and benefits data.
Strong communication skills; analytical; ability to organize work effectively, determine priorities; works well independently and as a team player.
Skilled and proficient in applying highly technical principles and concepts.
Demonstrated ability to interact with a wide variety of individuals and to handle complex situations simultaneously.

PHYSICAL REQUIREMENTS

Utilizing computers over prolonged periods of time.
Must maintain confidentiality; may be necessary to work and attend meetings outside facility or normal business hours; may be required to work evenings and weekends.

The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

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More about this job

Skills

Guide staff
Case management
Regulatory compliance
CMS
Strategic planning
Problem solving
Health education
CPT
Microsoft Office
Communication skills
Work in an organised manner
Confidentiality
Attend meetings

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