Jobs in the United States

25+ jobs

Save this search

Added 15 mins ago
Membership Sales Specialist
MHC Property Management, LP
Gordonville, TX · Point, TX
Responsible, along with Resort Manager, for the inventory of all flyers and the proper signage at the resort.
Added 22 mins ago
RI
Flight Nurse Full Time -Philadelphia
REVA INC
Philadelphia, PA · Fort Lauderdale, FL
- Full-time
Provides orientation and mentoring for new program/flight crew members, medical and aviation.
Added 39 mins ago
UO
Research Services Intermediate Professional
University of Colorado Denver
Aurora, CO
- $52,030 to $69,720 USD / year
Working under the direction of the Core Manager and Director, you will handle the full experimental lifecycle-from biomolecule extraction and sample preparation of cell cultures and tissues…
Added 45 mins ago
EB
Key Holder - Le Labo - Full Time - West Palm Beach, FL
ELC Beauty LLC
West Palm Beach, FL
- $19.25 to $24 USD / hour
- Full-time
We are looking for a dynamic and inspirational Key Holder to support the Store Manager and Assistant Manager to ensure the smooth efficient running of the Store. You will use your…
Added 1 hour ago
R
$21/HR FULL-TIME Assistant Manager
Regal
BOLINGBROOK, IL
- Full-time
The AST will assist the General ,Manager to lead and coach your team to provide great experiences for our guests, create an environment where engagement, diversity and showmanship are…
Added 1 hour ago
Lube Technician
BUDDY OP I LLC
Morgan City, LA · Lafayette, LA · Houma, LA
Certification from an automotive service excellence program (e.g., ASE).
Added 1 hour ago
Emerging Store Manager
Walgreens
PASADENA, MD
Successfully completes Store Manager learning and development program. Completes all required learning and development courses, certification, and any training assigned by Store Manager,…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
Engineering Operation Technician
Amazon Data Services, Inc.
Wharton, TX
You’ll join a diverse team of software, hardware, and network engineers, supply chain specialists, security experts, operations managers, and other vital roles. You’ll collaborate with…
Added 1 hour ago
UO
PRN MFM Sonographer
University of Colorado Denver
Aurora, CO
- $40,123 USD / year
This position reports directly to the MFM Practice Manager and indirectly to the Medical Directors and the Division Administrative Director.

COMMUNITY HEALTH GROUP

Manager - Utilization Management Manager

Chula Vista, CA, United States

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

Apply About employer

Applications open in a new tab.

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.

Apply About employer

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

Report this job