297 utilization management jobs at 133 companies in Philadelphia, PA
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Utilization Management Nurse
Philadelphia, Pennsylvania, United States
$92k-$117k/yr OnsiteFull Time
5+ YOEAssess clinical data for medical necessity, coordinate utilization reviews, validate authorizations with payers and physicians; requires RN (PA), 5+ years acute clinical nursing, knowledge of payer processes and portal navigation.
Microsoft Office, InterQual
1mo
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Utilization Management Coordinator - Philadelphia
Philadelphia, Pennsylvania, United States
$28-$35/hr OnsiteFull Time
Conduct concurrent utilization reviews for psychiatric and residential drug/alcohol clients using ASAM criteria; coordinate appeals, maintain authorization and denial logs, and communicate with payers and treatment teams.
Microsoft Office
1mo
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Utilization Management Coordinator - Philadelphia
Philadelphia, Pennsylvania, United States
$28-$35/hr OnsiteFull Time
Master's degree or nursing graduate with Pennsylvania licensure; knowledge of ASAM and medical necessity criteria; utilization review experience preferred; Microsoft Office and billing experience; strong communication and documentation skills.
Microsoft Office
2d
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Utilization Management Nurse RN
Newtown Square or United States
$60k-$107k/yr RemoteFull Time
3+ YOEAssociate's degree, unrestricted RN license, 3+ years of bedside nursing experience, advanced Microsoft application proficiency, internet navigation skills, and typing speed of 45 wpm.
Microsoft applications, InterQual, MCG, Microsoft Word
1w
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Manager of Utilization Management
Philadelphia, Pennsylvania, United States
FieldFull Time
5+ YOE2+ MgmtRequires an RN license, 5+ years in discharge planning and care coordination, 2+ years management or 4+ years supervisory experience, clinical leadership, data analysis, and Microsoft Office proficiency.
Microsoft Outlook, Microsoft Excel, Microsoft PowerPoint, Microsoft Word, MCG, InterQual, Electronic Medical Record (EMR)
2w
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Wound Care Utilization Management RN
Indianapolis or Iselin or Tampa or Miami or Wilmington or Cincinnati or St. Louis or Walnut Creek or Las Vegas or Woburn or Grand Prairie or Chicago or California or Illinois or Massachusetts or Nevada or New Jersey
$39-$56/hr RemoteFull Time
3+ YOERequires an associate degree in nursing or equivalent background, 3+ years of healthcare experience, active unrestricted RN license, and wound-care certification such as WOCN or CWS.
medical records
2mo
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Utilization Review Specialist
Chadds Ford, Pennsylvania, United States
HybridFull Time
1+ YOEBachelor's degree in a related field, 1+ years utilization review/case management or behavioral health revenue cycle experience, strong understanding of medical necessity and authorization processes, attention to detail, and strong communication skills.
EHR
1mo
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Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
Trenton, New Jersey, United States
$98k-$128k/yr OnsiteFull Time
4+ YOEBSN required (ADN with additional experience may be considered), active NJ RN, BLS recommended, 4+ years nursing experience with utilization review/case management, strong analytical and leadership skills.
1mo
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Utilization Specialist- OMY
Philadelphia, Pennsylvania, United States
OnsiteFull Time
2+ YOEBachelor's in human services/care management, 2 years mental health or social services experience, familiarity with EHRs, proficient with Microsoft Office, strong communication and analytical skills.
EHR, Microsoft Excel, Microsoft Word, Microsoft PowerPoint
4w
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RN Utilization Management - Day Shift
Newark, Delaware, United States
$86k-$137k/yr OnsiteFull Time
3+ YOEDE or compact RN license, Bachelor’s in Nursing required, minimum 3 years acute care RN and 3 years utilization management, denial management and insurer experience, 8 CEUs/year in utilization/case management.
2w
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Utilization Review Coordinator – Behavioral Health
Jackson Township, New Jersey, United States
OnsiteFull Time
1+ YOEManage authorization workflows and client caseloads, collaborate with clinical and billing teams, maintain accurate electronic UR documentation; high school diploma/GED required; 1+ year healthcare experience preferred.
1d
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Manager of Utilization Review
St. Johns or King of Prussia
OnsiteFull Time
3+ YOERequires Michigan LMSW, LPC, RN, or LVN licensure and 3–5 years of direct clinical experience in a psychiatric or mental health treatment setting.
BCBS, Delta, VSP
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Business Finance Revenue Cycle Utilization Manager
Chicago or Austin or Atlanta or United States or Denver or Detroit or Philadelphia or Houston or Tampa or Dallas or Charlotte or Raleigh or Louisville
RemoteFull Time
5+ YOE3+ MgmtBachelor's degree or 5+ years relevant experience, prior management experience, 3–5 years managing hourly staff, strong communication and analytical skills, and revenue cycle or healthcare systems experience.
BrainTree, AVATAR, iserve, Salesforce, EMR, SOX 404
1mo
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Senior Manager, Project Management
Monrovia or Los Angeles or Reading
$184k-$270k/yr OnsiteFull Time
15+ YOE12+ Mgmt15+ years in power/utilities (12+ in project management), Bachelor's/Master's in Engineering or equivalent, PE preferred, project management certification preferred, Microsoft Office proficiency, leadership and financial management experience.
Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Teams
1mo
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Senior Manager, Project Management
Los Angeles or Long Beach or Monrovia or Reading
$184k-$270k/yr OnsiteFull Time
15+ YOE12+ MgmtSenior leader with 15+ years in power/utilities including 12+ years in project management; experience delivering transmission, distribution, substation and grid modernization projects; Bachelor's/Master's in engineering or equivalent; PE and PM certifications preferred; Microsoft Office proficiency.
Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Teams
5d
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Licensed Water Operator
Perkasie, Pennsylvania, United States
FieldFull Time
5+ YOEHigh school diploma or equivalent and at least five years of operations management or engineering experience. State water/wastewater license preferred; must perform field and plant operations tasks.
3w
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Case Management RN
Wilmington, Delaware, United States
OnsiteFull Time
5+ YOEDiploma/associate required (BSN preferred). Active RN license, case management/utilization management certification preferred, minimum 5 years progressive clinical experience including utilization/case management, maintain DE state and federal clearances.
2w
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RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)
Philadelphia, Pennsylvania, United States
HybridFull Time
2+ YOEActive PA or multi-state RN license, BSN required, minimum 2 years clinical nursing experience preferred; experience with utilization review/InterQual/MCG and Medicare/Medicaid guidelines; strong clinical judgment and communication.
InterQual, MCG
1mo
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Oracle Utilities Meter Data Management (MDM) Functional Lead
Albany or Arlington or Atlanta or Austin or Beaverton or Bentonville or Boston or Carmel or Charlotte or Chicago or Cincinnati or Cleveland or Columbus or Culver City or Denver or Des Moines or Detroit or Hartford or Houston or Irving or Kirkland or Miami or Milwaukee or Minneapolis or Morristown or Mountain View or Nashville or New York City or Oklahoma City or Overland Park or Philadelphia or Pittsburgh or Raleigh or Redmond or Sacramento or San Diego or San Francisco or Scottsdale or Seattle or St. Louis or St. Petersburg or Walnut Creek or United States
$59k-$196k/yr OnsiteFull Time
3+ YOERequires 3+ years with Oracle Utilities CCS/MDM in U.S. utilities, VEE configuration experience, utility project experience, and a bachelor's degree or equivalent work experience.
Oracle Customer Cloud Service (CCS), Oracle Utilities Meter Data Management (MDM), Oracle Utilities Customer Care and Billing (CC&B), Oracle Integration Cloud (OIC), Oracle Analytics Cloud (OAC), Oracle, AMI, VEE, HES, GIS, OMS, SCADA, ISO, FERC, ANSI C12, Green Button, NAESB, AMI 2.0, Itron, Landis+Gyr, Sensus, Honeywell, Time-of-Use (TOU), Critical Peak Pricing (CPP), Net Energy Metering (NEM), Distributed Energy Resources (DER), BI
5d
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Energy Portfolio Utility Specialist
Ridgeland or Troy or New York City or Houston or Chicago or Grand Rapids or Owings Mills or Baltimore or Columbia or Memphis or Boston or San Jose or Austin or Kalamazoo or Spokane or Denver or Fort Worth or Atlanta or Milwaukee or Madison or McLean or Huntsville or Melville or Philadelphia or Charlotte or Greenville or Costa Mesa or Fort Lauderdale or Cincinnati or Cleveland or Columbus or Akron or Cherry Hill or Tampa or Minneapolis or Anchorage or Salt Lake City or Norfolk or Jacksonville or Boulder or Nashville or Oak Brook or Las Vegas or Indianapolis or Walnut Creek or Daphne or Mobile or Baton Rouge or Biloxi or Gulfport or Hattiesburg or Brentwood or Jackson or Arcadia or Tavares or Rolling Fork or Alturas or Silver City or Fort Myers or Forest or Clearwater or Greenville or Asheville or Greenwood or Boone or Aiken or Perry or Columbia or Belzoni or Naples or Amory or Chiefland or Palatka or Moss Point or Vero Beach or Edwards or Bidhan Nagar
$125k-$150k/yr HybridFull Time
5+ YOEBachelor’s degree and 5+ years in energy efficiency, utilities, or consulting, including utility or state-agency demand-side management, demand response, or greenhouse-gas reduction programs.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Demand-Side Management (DSM), Demand Response, Measurement and Verification (M&V), Project Management Professional (PMP), Certified Energy Manager (CEM), Business Energy Professional (BEP), Building Performance Institute (BPI), Leadership in Energy and Environmental Design (LEED)
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