Jobs in the United States

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Added 1 min ago
Sr. Global Supply Manager, Networking Switches
Amazon Data Services, Inc.
Seattle, WA
- 2+ years of program, project or product management, or leading product implementation experience
Added 1 min ago
Payroll Manager
KBS
Oceanside, CA
Oversees new manager training on payroll related tasks, coordinating with field training team
Added 2 mins ago
Janitorial Zone Manager
KBS
Van Nuys, CA
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 2 mins ago
Janitorial Zone Manager
KBS
SUFFOLK, VA
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 2 mins ago
Janitorial Zone Manager
KBS
Fort Wayne, IN
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 2 mins ago
Janitorial Zone Manager
KBS
NASHUA, NH
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 2 mins ago
Janitorial Zone Manager
KBS
South Portland, ME
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 2 mins ago
Janitorial Zone Manager
KBS
New York, NY
Kellermeyer Bergensons Services (KBS) has an immediate full-time opportunity to join our operations team as a Zone Manager in ENTER HERE . If you enjoy working in a fast-paced environment…
Added 3 mins ago
Procurement Project Manager
Thales Avionics, Inc. (AGS)
United States
Thales is looking for a Procurement Project Manager to act as the strategic procurement lead for project deliveries, with end-to-end accountability for procurement performance across cost,…
Added 5 mins ago
Relationship Administrative Specialist
Frost Bank
Boerne, TX
…and organization. You enjoy assisting Loan Officer (s) with project and implementation of policies within the department; preparing special reports, gathering, and summarizing data; acting…
Added 6 mins ago
Project Manager
Velocity Electronics Corp.
Remote, United States
Turning Ideas into Action. Enabling Business Success. At Velocity Electronics, a Jabil Company, we are seeking a Jr. Project Manager to join our Information Technology team.
Added 6 mins ago
SLED Account Manager
HP
Spring
Impacts multiple teams and may act as a team or project leader providing direction to team activities and facilitates information validation and team decision making process.
Added 6 mins ago
AC
Project Manager I
AIR Communities
Denver, CO
- $75,000 to $85,000 USD / year
Communicate weekly project status reports to team/manager, highlighting progress, risks, and key milestones.
Added 7 mins ago
CO
Project Manager
City of Chico
Chico, CA
- $46.83 to $62.76 USD / hour
Serves as project manager for a wide variety of public works and other capital improvement projects, including but not limited to, construction administration, traffic studies, and master…
Added 7 mins ago
Senior Network Security Engineer
Applied Materials
Santa Clara, CA · Santa Clara
…responsibility for Palo Alto Networks NGFW, Panorama, Strata Cloud Manager, firewall policy architecture, security controls, lifecycle management, advanced troubleshooting, and automation…
Added 10 mins ago
Pharmacy Manager, Memorial City
Memorial Hermann Health System
United States
Memorial Hermann Memorial City seeks an experienced Pharmacy Operations Manager to join our team!
Added 11 mins ago
Supply Chain Transfer Program Manager
ASML US, LLC. (US01)
San Jose, CA
As a Supply Chain Transfer Manager, you will lead cross-functional teams responsible for managing critical supply chain transfers. Your goal is to ensure the timely and reliable…
Added 14 mins ago
Senior Microsoft Platform Engineer
Systems Engineering Solutions Corporation
Alexandria, VA
Program Description: The program provides end to end IT Infrastructure support services, including Tier 1 Help Desk, Tier 2 End User Support, Tier 3 Server, Platform, and Network…
Added 14 mins ago
Manager, Supply Chain Management - Repair Purchasing & Logistics
National Steel and Shipbuilding Com
San Diego, CA
…prevent and resolve problems that may impact quality, schedule or program…
Added 16 mins ago
Technical Program Manager 3
Lam Research
Tualatin
Part of a dynamic team to create LAM's new products in a fast-paced NPI environment. Monitors the new product program from initiation through delivery, including planning and directing…
Added 17 mins ago
Director, Securities & Corporate Governance
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Los Angeles, CA
Time/Project Management: Effectively manage multiple, significant activities and respond to changing
Added 17 mins ago
Principal Engineer Systems RQ-4 FMS IFC Manager
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Must have experience in a systems engineer, technical project engineer, or technical program manager role on complex systems or software-intensive programs.
Added 18 mins ago
Human Resource Coordinator
Natera
Pleasanton, CA · San Carlos, CA
…onboarding and offboarding temporary employees. Reporting to the Manager, HR Operations, this role processes personnel transactions, responds to employee inquiries, and coordinates with…
Added 18 mins ago
QA & QC Manager T&D
MYR Group
Alvarado, TX
The Quality Assurance/Quality Control Manager in Transmission and Distribution is responsible for conducting audits of projects and quality standards. This individual develops a standard…
Added 18 mins ago
Chief Engineer Level 5 - Linthicum
Northrop Grumman
Baltimore
Leadership experience should include at least five of the following: project planning, cost and schedule management and tracking, technology management, risk management, performance…

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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