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Added 4 mins ago
W
Case Manager-Transitional Housing
Win
Brooklyn, NY
- $26.76 USD / hour
Win is seeking a dedicated and compassionate Case Manager to support families residing in our Transitional Housing programs. In this role, you will provide comprehensive case management…
Added 4 mins ago
W
Case Manager-Transitional Housing
Win
Brooklyn, NY
- $26.76 USD / hour
Win is seeking a dedicated and compassionate Case Manager to support families residing in our Transitional Housing programs. In this role, you will provide comprehensive case management…
Added 4 mins ago
W
Case Manager-Transitional Housing
Win
Brooklyn, NY
- $26.76 USD / hour
Win is seeking a dedicated and compassionate Case Manager to support families residing in our Transitional Housing programs. In this role, you will provide comprehensive case management…
Added 4 mins ago
W
Case Manager-Transitional Housing
Win
Brooklyn, NY
- $26.76 USD / hour
Win is seeking a dedicated and compassionate Case Manager to support families residing in our Transitional Housing programs. In this role, you will provide comprehensive case management…
Added 9 mins ago
Evening Front Office Supervisor
Schulte Companies
Chapel Hill, NC
Promote teamwork and associate morale. Treat people with respect. Recognize associate successes.
Added 11 mins ago
SAP Program Management Senior Manager
Accenture LLP Company
3900 Great Plains Dr. S., MS · NY
As a Program Management Lead, you orchestrate the successful delivery of complex, multi-workstream programs by bringing together business, functional, technical, deployment, testing, data,…
Added 37 mins ago
CHEESE SHOP/CLERK
The Kroger Co.
Washington, IL · IL
…that encourages our customers to return. Assist department manager in achieving sales and profit goals established for the department, and monitor and control all established quality…
Added 37 mins ago
Retail Merchandising & Inventory Supervisor
Staples
East Falmouth, MA
Full-time hours, generous paid time off, career development program and weekly pay
Added 37 mins ago
Medication Specialist
Veterans Inc.
Worcester, MA
…information and needs. Reporting directly to the Residential Recovery Program Manager, this employee will be responsible for ensuring the flawless execution of medication tracking, safety…
Added 37 mins ago
Senior Manager, QC Analytical-1
Bristol Myers Squibb
Devens, MA
Bristol Myers Squibb is seeking a Senior Manager for QC Analytical at the Cell Therapy Facility (CTF) in Devens, MA. This role supports the QC analytical operations team, develops and…
Added 49 mins ago
W
Pharmacy Customer Service Associate
Walgreens
LITTLETON, CO
- $17.5 to $21.5 USD / hour
Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the…
Added 50 mins ago
Deli Clerk
The Kroger Co.
Woodland Park, CO
…that encourages our customers to return. Assist the department manager in reaching sales and profit goals established for the department and monitor all established quality assurance…
Added 53 mins ago
BB
Associate Designer, Parker Dresses
BCI Brands
NY · New York, NY
- $70,000 to $80,000 USD / year
…target customer's fit criteria based on direction from their…
Added 1 hour ago
Electrical/I&C/Combustion Turbine Technician
Nebraska Public Power District
Hallam, NE
This position will report to the Electrical/I&C/Combustion Turbine Manager.
Added 1 hour ago
Manufacturing Group Leader
Toyota Boshoku America Inc
Jackson, TN
Plan and coordinate hiring and placement of team members with his/her Assistant Manager. Monitor and track staffing conditions, work hours and overtime, job rotation, and absenteeism.
Added 1 hour ago
Production Control Group Leader Evening
Toyota Boshoku America Inc
Princeton, IN
Plan and coordinate hiring and placement of team members with his/her Assistant Manager. Monitor and track staffing conditions, work hours and overtime, job rotation, and absenteeism.
Added 1 hour ago
Cashier
The Kroger Co.
Kennewick, WA
· Practice preventive maintenance by properly inspecting equipment and notify appropriate department or store manager of any items in need of repair.
Added 1 hour ago
STARBUCKS/BARISTA
The Kroger Co.
Louisville, KY
Report product ordering/shipping discrepancies to the department manager
Added 1 hour ago
Safety Coordinator (Field)
Performance Food Group
TX
Responsible for administrative and safety related support activities, under the direction of the Safety Manager, to monitor, administer, implement, maintain and report on the location's…
Added 1 hour ago
OL
Case Manager II Community Health
Oakland Livingston Human Service Agency
Pontiac, MI
- $21.7 USD / hour
Added 1 hour ago
General Manager - Optical
America's Best
Holland, MI
As a General Manager, you’ll lead a talented team, drive results, and create an amazing experience for both patients and associates every single day.
Added 1 hour ago
W
Auto Care Center Service Manager
Walmart
LIVONIA, MI
- $20 to $33 USD / hour
…is a rewarding place to work with opportunities for advanced associate training, business development, and application of…
Added 1 hour ago
Nighttime Team Member Shifts after 4pm
Potbelly Sandwich Works LLC
Warren, MI
Added 1 hour ago
Registered Nurse- Assistant Nurse Manager
Veterans Affairs, Veterans Health Administration
Ann Arbor, MI
Added 1 hour ago
CO
PROGRAM SPECIALIST - RISK ANALYST I
City of Stockton
Stockton, CA
- $38.48 USD / hour
Performs analytical work under the direction of the Risk Manager or designee, which requires the application of technical skills and knowledge of detailed or specialized activities related…

PROMESA R.H.C.F.

Utilization Manager

Brooklyn, NY, United States

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Job details

Experience: Minimum of 2 years of case management and/or utilization review experience
Posting language: English
Posted: Jan 7, 2026

Original job description

•

MISSION STATEMENT

Are you ready to give back to the community while pursuing your passion? For over 50 years, Acacia Network and its affiliates have been committed to improving the quality-of-life and wellbeing of underserved communities in New York City and beyond. We are one of the leading human services organizations in New York City and the largest Hispanic-led nonprofit in the State, serving over 150,000 individuals every year. Our programs serve individuals at every age and developmental level, from the very young through our daycare programs to mature adults through our older adults centers. Our extensive array of community-based services are fully integrated, bilingual and culturally competent.

POSITION OVERVIEW

The Utilization Manager is responsible for the day-to-day functions of collaborative communication with external case managers at referring provider facilities and/or managed care organizations (MCO) for data collection, interpretation, and certification/recertification from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect to MCO requisites. In addition, this position is responsible for having a thorough understanding of patient treatment plans through participative discussions with the care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing residential services requiring MCO approval.

KEY ESSENTIAL FUNCTIONS

Obtaining the required pre-authorization/certification of specified services from the MCO and communicating end of benefit status and/or reimbursement changes to Finance and others as deemed necessary.
Conducting ongoing medical necessity reviews, which may be pre-service, concurrent and/or retrospective in nature, by evaluating clinical data and submitting appropriate documentation to update the patient/resident’s status to the MCO as scheduled.
Acting as a liaison between the residential program and the MCO to better facilitate the reimbursement process.
Referring MCO denials and non-covered medical services to the directors for appeal determination and next steps
Conduct medical record reviews of all managed care patients within the first 24 to 72 hours (if admitted on a Friday after 5:00pm) then weekly as required to promote desired clinical and financial outcomes by, but not limited to:
Meeting with all managed care residents/patients to better assist in the selection of appropriate provider resources and identification of quality and cost-effective services throughout the continuum of care.
Acting as a resource to the interdisciplinary team regarding MCO requirements for admission, continued stay and discharge planning.
Providing early identification of covered care and ensuring that claims are approved when the requirements are met.
Collaborate with clinicians to identify discharge needs and coordinates with Social Services in the creation and implementation of a discharge/transfer plan.
Coordinates post-discharge follow-up care with selected patients and community providers.
Maintains strong leadership skills to perform the multiple functions and a wide variety of tasks requiring independent judgment, ingenuity, and initiative.
Interacts with executives, directors, key members of the residential team, physicians, and their staff, third party payers, state and federal agencies, auditors, and vendors.
Maintains a high degree of computer proficiency with MS Word and MS Excel which is critical for the analysis conducted using this technology.
Maintains all information in a manner such as to assure strict confidentiality and compliance with HIPPAA.
Maintains full knowledge and understanding of state and federal regulations as they pertain to resident assessment requirements.
Performs all other tasks including miscellaneous special projects as directed.

REQUIREMENTS

Minimum of 2 years of case management and/or utilization review experience
Associate degree required; bachelor's Degree preferred.
Strong problem-solving and advanced analytical skills necessary to read, understand, interpret, and analyze statistical data.
Excellent oral, written, organizational and interpersonal communication skills.
Ability to communicate effectively with senior leadership as well as other clinical/nonclinical directors, managers, staff, consultants and MCOs.
Demonstrated ability to effectively collaborate with peers and senior leadership on project assignments and group presentations.

WHY JOIN US? Acacia Network provides a comprehensive and competitive benefits package to our employees. In addition to a competitive salary, our benefits include medical, dental, and vision coverage. We also offer generous paid time off, including vacation days and paid holidays, to support a healthy work-life balance. We prioritize the well-being of our employees both professionally and personally. As an Equal Opportunity Employer, we encourage individuals from all backgrounds to apply.

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Skills

Communication skills
Documentation
Leadership
Microsoft Word
Microsoft Excel
Confidentiality
Regulatory compliance
Case management
Problem solving
Analytical skills
Presentation skills

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