Utilization Management Director jobs in Portsmouth, NH

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

H
Utilization Management Administration Coordinator
  • Humana
  • Portsmouth, NH FULL_TIME
  • Become a part of our caring community and help us put health first
     

    Humana Healthy Horizons in Ohio is seeking a Utilization Management Administration Coordinator 2 who contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

    You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as we have grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you are working from home, from the field, from our offices, or from somewhere in between—you will feel welcome here. We are a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It is up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

    * Health Insurance begins on day one!
    * 23 days of vacation with pay per year
    * Aggressive 401K program matching 125% of 6% after year one!

    Are you caring, Curious and Committed? If so, apply today!

    The UM Administration Coordinator 2:

    • Provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members
    • Decisions are typically focus on interpretation of area/department policy and methods for completing assignments
    • Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction
    • Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion


    Use your skills to make an impact
     

    Required Qualifications

    • 1 or more years administrative or technical support experience
    • Excellent verbal and written communication skills
    • Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
    • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
    • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

    Preferred Qualifications

    • Proficient utilizing electronic medical record and documentation programs
    • Proficient and/or experience with medical terminology and/or ICD-10 codes
    • Bachelor's Degree in Business, Finance or a related field
    • Prior member service or customer service telephone experience desired
    • Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

    Additional Information

    About Humana

    Your growth is what drives Humana forward. 

    • When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we do not grow without you
    • This is a place where our nurses influence the C-suite.
    • Where software engineers change lives.
    • Where every associate can build a professional path where they learn and thrive.
    • Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
    • Because finding new ways to put health first—for our members and patients and our associates alike—is what we do. 

    Work at Home Guidance

    To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

    • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
    • Satellite, cellular and microwave connection can be used only if approved by leadership.
    • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
    • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

    Interview Format

    As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

    You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

    Scheduled Weekly Hours

    40

    Pay Range

    The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


     

    $37,200 - $51,200 per year


     

    Description of Benefits

    Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


    About Us
     

    Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


    Equal Opportunity Employer

    It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

  • Just Posted

N
Director of Construction and Contract Management
  • NV5
  • Portsmouth, NH OTHER
  • Overview NV5 is a provider of engineering and consulting services to public and private sector clients, delivering solutions through six business verticals: Testing, Inspection & Consulting; Infrastru...
  • 28 Days Ago

G
Rooms Director - AROGME
  • Giri Hotel Management
  • Ogunquit, ME FULL_TIME
  • We are seeking a dynamic, hands on, customer service driven individual to manage and lead our Guest Services Department at Anchorage by the Sea. Must be detail oriented, able to work on own and in a t...
  • 2 Days Ago

G
Food Service Director
  • GreenTree Healthcare Management
  • Portsmouth, NH FULL_TIME
  • Immediately Hiring Food Service Director! We are Edgewood Center, and we are looking for the best and brightest to help us change long term care. At Edgewood we believe that happy, appreciated staff l...
  • 1 Month Ago

H
Regional Director of Revenue Management (Remote)
  • Hay Creek Hotels
  • Exeter, NH FULL_TIME
  • Job Description: Hay Creek Hotels has developed an exciting new position for a Regional Director of Revenue Management to join our growing team of hospitality professionals. The Regional Director of R...
  • 1 Day Ago

P
Utilization Review Specialist
  • PMC Medical Group
  • Somersworth, NH FULL_TIME
  • PMC Medical Group, a well-established independently owned multi-disciplinary practice, is seeking a full-time Utilization Review Specialist. Summary: Provide comprehensive assessment, planning, implem...
  • 22 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Utilization Management Director jobs found in Portsmouth, NH area

G
Deburring & Grinding Technician
  • Granite State Manufacturing
  • Manchester, NH
  • De-burr, polish, sand, finish and clean machined parts made of various metals, plastics or other materials. Essential Fu...
  • 4/26/2024 12:00:00 AM

F
Dietary Clerk (Food Service)
  • First Atlantic Corp.
  • Saco, ME
  • ** Dietary Clerk (Food Service)** ** Seal Rock Health Care** ** Saco, ME** Schedule: **Full-Time** Shift: **Days** This ...
  • 4/26/2024 12:00:00 AM

G
Welder, Class A
  • Granite State Manufacturing
  • Manchester, NH
  • POSITION SUMMARY Fabricates and welds a variety of metals from sheet stock to heavy plate. Welding processes utilized in...
  • 4/26/2024 12:00:00 AM

G
Welder, Class A
  • Granite State Manufacturing
  • Manchester, NH
  • POSITION SUMMARYFabricates and welds a variety of metals from sheet stock to heavy plate. Welding processes utilized inc...
  • 4/25/2024 12:00:00 AM

E
Risk Management Analyst
  • Enterprise Bank
  • Lowell, MA
  • We are Hiring! Risk Management Analyst - Lowell, MA Enterprise Bank, is a growing and successful commercial bank where y...
  • 4/23/2024 12:00:00 AM

F
Director, Product Management
  • Fidelity TalentSource LLC
  • Merrimack, NH
  • Job Description: Position Description: Creates, maintains, and communicates multi-year product roadmaps. Owns the produc...
  • 4/22/2024 12:00:00 AM

G
Welder class A
  • Granite State Manufacturing
  • Manchester, NH
  • POSITION SUMMARY Fabricates and welds a variety of metals from sheet stock to heavy plate. Welding processes utilized in...
  • 4/22/2024 12:00:00 AM

G
Machinist (CNC Lathe: 1st Shift)
  • Granite State Manufacturing
  • Manchester, NH
  • Sets up and operates Computer Numerical Control (CNC) machines, manual machines, and machining centers to fabricate meta...
  • 4/22/2024 12:00:00 AM

Portsmouth is a city in Rockingham County, New Hampshire, United States. As of the 2010 census it had a population of 21,233, and in 2017 the estimated population was 21,796. A historic seaport and popular summer tourist destination on the Piscataqua River bordering the state of Maine, Portsmouth was formerly the home of the Strategic Air Command's Pease Air Force Base, since converted to Portsmouth International Airport at Pease. According to the United States Census Bureau, the city has a total area of 16.8 square miles (43.6 km2), of which 15.6 square miles (40.5 km2) is land and 1.2 square...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$131,626 to $177,985
Portsmouth, New Hampshire area prices
were up 1.4% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020