Utilization Manager Jobs in Raleigh, NC

Champion the Utilization Management program by leading a team to ensure high-quality service and adherence to clinical guidelines. Collaborate across functions to drive performance, facilitate continu...

Champion utilization management by assessing patient status, ensuring compliance with regulations, and collaborating with healthcare teams to optimize care delivery and mitigate denials while supporti...

Transform clinical review processes by validating patient status alignment with care standards and regulatory requirements. Collaborate with healthcare teams to enhance documentation accuracy and supp...

Collaborate with patients, families, and interdisciplinary teams to optimize care management processes, ensuring quality and efficiency from admission through discharge while protecting revenue and fa...

Partner with us to lead clinical excellence and quality outcomes in healthcare. Drive utilization management strategies, enhance provider engagement, and support population health initiatives as a tru...

Drive workforce efficiency by leading a team of WFM Analysts, ensuring optimal scheduling and operational accountability across Contact Center and Back Office environments while addressing staffing an...

Analyze service requests and determine medical necessity for optimal care levels. Provide clinical consultations, interpret documentation, and guide referrals. Engage in appeals and support consistent...

Shape the future of healthcare by driving sales success within payer and provider organizations. Your strategic vision and collaborative approach will influence key stakeholders and streamline impactf...

Manage claims operations and team performance to ensure compliance and efficiency. Oversee claims processing, data integrity, and reporting, while driving improvements through analysis and cross-funct...

Champion impactful partnerships by driving engagement and success with health system/provider networks. Utilize clinical research knowledge to foster collaboration among cross-functional teams and enh...

Lead the execution of client implementation projects, ensuring alignment across cross-functional teams to enhance operational efficiency and exceed client expectations while driving process improvemen...

Shape client payment policies by ensuring accuracy, delivering specialized requests, and collaborating effectively with internal and external teams to enhance service and compliance within healthcare...

Partner with us to enhance healthcare services as a UM Nurse Consultant, leveraging your clinical expertise to assess, coordinate, and facilitate optimal care for members, while collaborating with var...

Elevate performance by serving as a crucial liaison in application support, optimizing usage and administration of key operational tools, and driving cross-functional collaboration to enhance efficien...

Drive exceptional service delivery by leading a skilled team of Implementation Consultants, ensuring successful deployment and adoption of connected operations solutions for enterprise clients while p...

Support transformative corporate performance management projects using OneStream XF. Collaborate with clients and leverage cross-functional expertise to drive successful implementations, optimize work...

Unlock potential by leading the governance and scaling of maintenance systems across automated warehouse operations, ensuring planning standards and execution discipline enhance uptime and cost contro...

Transform your career by leading a dynamic team to drive technical operations and enhance demo environments for global sales and marketing initiatives. Balance hands-on engineering with strategic proj...

Lead a high-impact team in a 24/7 operations center. Drive resolution of network issues while overseeing daily operations, team performance, and strategic improvements to enhance service delivery and...

Pioneer clinical excellence as you conduct outpatient authorization reviews, ensuring members receive appropriate care by utilizing evidence-based criteria and navigating complex guidelines. Your insi...

Unlock potential by leading utilization management efforts to ensure the delivery of high-quality, evidence-based behavioral health services. Collaborate with diverse teams to enhance patient outcomes...

Champion data quality and team development while driving innovations in triage processes. Lead a skilled team to enhance data reliability, establish workflows, and collaborate across functions to impl...

Join a team that's dedicated to leading clinical review audits, managing operations, and ensuring quality outcomes. Utilize your nursing expertise to support remote staff and drive strategic initiativ...

Join a team that drives DevOps excellence by managing a suite of collaboration tools, leading a team of administrators, and ensuring seamless tool operation for multiple development teams in a cloud e...

Lead complex healthcare technology implementations to enhance access, care coordination, and outcomes for movement-restricted populations, driving success through strong project management and collabo...