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Added 3 mins ago
Marketing Coordinator
Glacier Bancorp, Inc.
Chubbuck, ID
COMPENSATION & BENEFITS: Starting salary is dependent upon relevant experience and may vary based on the geographic location of the position. We offer an extensive benefits package that…
Added 7 mins ago
CR
Sales Manager (Part Time)
Carter's Retail Inc.
Sevierville, TN
- Part-time
As a Part Time Sales Manager, you will be the first face of the brand for growing families. You’ll congratulate new parents and grandparents, the first to introduce our new baby essentials,…
Added 11 mins ago
HR SPECIALIST
The GEO Group
Adelanto, CA
Process leaves of absence and ensure compliance with FMLA, ADA and applicable federal, state, and local laws.
Added 11 mins ago
EHS Programs Specialist
Global Partners
Newton, MA
The Environmental Health and Safety Programs Specialist is responsible for the continuous improvement of EHS programs that strengthen employee engagement, regulatory compliance,…
Added 19 mins ago
PI
Manufacturing Purification Manager
Pfizer, Inc.
MA
- $106,000 to $176,600 USD / year
…Performance Plan with a bonus target of 15.0% of the base salary and eligibility to participate in our share based long term incentive program. We offer comprehensive and generous benefits…
Added 29 mins ago
MT
Nurse (Clinical/Case Management)
Military Treatment Facilities under DHA
Pentagon, Arlington, VA
- $99,586 to $129,454 USD / year
About the Position: Incumbent serves as a Nurse (Clinical/Case Manager) responsible for analyzing problems associated with providing health care to patients and/or beneficiaries for the…
Added 29 mins ago
VH
Health Technician (Unit 4B) - Part-Time
Veterans Health Administration
Madison, WI
- $36,409 to $59,031 USD / year
- Part-time
The Health Technician position within the Acute Care and Mental Health Nursing Service is a vital part of the healthcare team at William S. Middleton Memorial Veterans Hospital. This role…
Added 29 mins ago
NP
Biological Science Technician
National Park Service
Porter, IN
- $56,409 to $73,333 USD / year
For current Federal employees, if hours worked per week are not included on your resume, you must submit a non-award SF-50 as part of your application to be used to validate your work…
Added 29 mins ago
NP
Environmental Protection Specialist
National Park Service
Porter, IN
- $68,999 to $89,703 USD / year
For current Federal employees, if hours worked per week are not included on your resume, you must submit a non-award SF-50 as part of your application to be used to validate your work…
Added 29 mins ago
VH
Program Analyst
Veterans Health Administration
Marion, IL
- $61,722 to $97,087 USD / year
The Marion VA Health Care System is seeking a Program Analyst to support the Chief of Staff (COS) Service. This position reports directly to the Group Practice Manager (GPM) and works…
Added 29 mins ago
IH
Dentist (Pediatric)
Indian Health Service
Gallup, NM
- $107,592 to $139,871 USD / year
To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying.
Added 29 mins ago
NP
Cultural Resources Program Manager
National Park Service
Jemez Springs, NM
- $75,489 to $98,141 USD / year
For current Federal employees, if hours worked per week are not included on your resume, you must submit a non-award SF-50 as part of your application to be used to validate your work…
Added 29 mins ago
GS
Supervisory Hydrologic Technician
Geological Survey
Pembroke, NH
- $101,375 to $131,790 USD / year
…hiring, retention, employee relations, performance management, and the allocation of personnel, financial, and program resources to support the Department's capacity to manage its programs…
Added 31 mins ago
VH
Acute Care Critical Care Nurse
Veterans Health Administration
Bay Pines, FL
- $78,939 to $150,808 USD / year
Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed…
Added 31 mins ago
Physical Therapist - Fee
Veterans Health Administration
Perry, GA
Provide recommendations for mobility equipment, therapeutic exercise programs, and safety strategies to support functional independence
Added 31 mins ago
PS
Supervisory Physician
Program Support Center
Atlanta, GA · Washington, DC · Kansas City, MO · Dallas, TX · Charleston, SC · Rockville, MD · Location Negotiable After Selection
- $126,384 to $164,301 USD / year
Provide leadership and technical direction to ensure programs comply with applicable federal laws, regulations, agency policies, healthcare accreditation standards, and evidence-based…
Added 31 mins ago
CF
Physician (Public Health)
Centers for Disease Control and Prevention
Atlanta, GA
- $133,007 to $172,915 USD / year
Providing clinical expertise to federal, state, and local public health agencies/organizations regarding mycotic (fungal) disease prevention program activities.
Added 31 mins ago
NP
Community Planner
National Park Service
El Portal, CA
- $75,055 to $116,949 USD / year
…gateway communities, contractors, Support Offices, Region, Federal Highway Administration (FHWA) and Washington Support Office (WASO).- The incumbent assists with facilitating…
Added 32 mins ago
Hazardous Area Classification (HAC) Subject Matter Expert (SME)
ProSidian Consulting, LLC
Richland, WA
…Matter Expert (SME) | Hazardous Area Classification Review and Training Support for Program Support on an Exempt Basis for Work on Client Site in the Pacific Northwest Region, Washington…
Added 32 mins ago
Quality Assurance Engineer
ProSidian Consulting, LLC
Richland, WA
ProSidian seeks a Quality Assurance Engineer | Hazardous Area Classification Review And Training Support for Program Support on a Exempt Basis for Work On Client Site in The Pacific…
Added 32 mins ago
Construction Project Manager
ProSidian Consulting, LLC
Brookhaven, NY
ProSidian seeks a Construction Project Manager | Project Infrastructure Independent Construction Cost Estimate [A-E Cost Estimation Services] for Program Support on an Exempt 1099 Contract:…
Added 34 mins ago
FS
Loan Assistant/Specialist (Agricultural)
Farm Service Agency
Waite Park, MN
- $44,410 to $87,482 USD / year
Conducts interviews with loan applicants, reviews loan applications, and makes preliminary inquiries to develop factual information to assess the eligibility of applicants. | Providing…
Added 34 mins ago
NI
Pharmacist
National Institutes of Health
Montgomery County, MD · Phoenix, AZ
- $93,629 to $133,142 USD / year
Design and conduct interdisciplinary educational programs in the area of drug therapy.
Added 34 mins ago
FA
Supervisory Aviation Technical Systems Specialist
Federal Aviation Administration
Fort Worth, TX
- $121,519 to $188,392 USD / year
The selectee is responsible for overseeing and supervision of ADO staff administering the Airport Improvement Program (AIP) and the Passenger Facility Charge (PFC) program ensuring, at a…
Added 34 mins ago
CF
Nurse Educator
Centers for Disease Control and Prevention
Atlanta, GA
- $112,556 to $146,325 USD / year
Plan, develop, and oversee continuing education programs, training initiatives, and accreditation activities for healthcare professionals.

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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More about this job

Skills

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

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