> Markdown version of [/jobs/ext/2024765-manager-utilization-management](https://www.wearedevelopers.com/jobs/ext/2024765-manager-utilization-management). Every page supports `.md` or `Accept: text/markdown`. Links point to the HTML versions so they work for humans too. Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # Manager, Utilization Management - **Company:** Catholic Health Services - **Location:** Smithtown, NY, United States - **Experience:** Expert - **Salary:** $160,000.0 - **Contract:** Permanent contract - **Skills:** Microsoft Word, Microsoft Excel, Hospital Information Systems, Microsoft Office, Electronic Medical Records - **Published:** August 11, 2026 - **Apply:** https://www.juju.com/job/00000000gmlx8t ## About the Role + Graduate of an accredited School of Nursing with a current New York State Registered Nurse (RN) license required. + BSN or Bachelor's degree in a healthcare-related field preferred. + Minimum of five (5) years of recent clinical experience in medical-surgical nursing or a relevant specialty area. + Previous Utilization Management and/or Care Management experience in an acute care hospital or managed care setting required. + Commitment to ongoing professional development through continuing education and certification related to Utilization and Care Management. + Proficiency with Microsoft Office applications, including Word and Excel; experience with EPIC, Midas, STAR, and other hospital information systems preferred. + Ability to obtain specialty-specific clinical consultation when needed to support utilization reviews and appeals. + Strong understanding of reimbursement methodologies, utilization management principles, and financial implications of clinical decisions. + Knowledge of evidence-based clinical guidelines and medical necessity criteria. + Familiarity with federal, state, Peer Review Organization (PRO), and managed care regulations preferred. + Working knowledge of payer requirements, medical necessity guidelines, levels of care, continuity of benefits, and utilization review processes. + Understanding of current healthcare trends, managed care principles, patient care best practices, and performance improvement methodologies. ## Description The Utilization Management Manager (UMM) proactively conducts clinical reviews according to industry accepted clinical criteria guidelines. The UMM serves as interdepartmental liaison identifying level of care and opportunities for improvement from both internal and external sources including regulatory agencies. Responsibilities + Conduct clinical reviews in accordance with contractual, regulatory, and organizational requirements. + Collaborate with the Physician Advisor on clinical review discussions as appropriate. + Serve as a liaison between the Care Management Department and attending physicians. + Communicate changes in patient level of care to the Care Manager based on physician orders and updated clinical information. + Provide guidance to Care Management staff on regulatory, utilization management, and managed care requirements. + Monitor compliance with departmental performance standards. + Participate in departmental meetings, committees, and interdisciplinary initiatives as assigned. + Identify regulatory, managed care, and compliance issues contributing to denials and report findings to department leadership. + Support administrative staff by providing information, guidance, and operational assistance. + Facilitate effective communication across departments to ensure continuity of care and collaboration. + Maintain strict patient confidentiality and protect electronic health information in compliance with hospital policies, HIPAA, New York State regulations, and Peer Review Organization (PRO) requirements. ## Related Videos - [ZEISS & Microsoft - Building the Next Generation Medical Ecosystem in the Cloud](https://www.wearedevelopers.com/videos/424-zeiss-microsoft-building-the-next-generation-medical-ecosystem-in-the-cloud) - [Developing the Rich Text Editor for DeepL.com](https://www.wearedevelopers.com/videos/1172-developing-the-rich-text-editor-for-deepl-com) - [In-depth .NET Azure Functions: Isolated mode, performance and durable AI agents](https://www.wearedevelopers.com/videos/100207-in-depth-net-azure-functions-isolated-mode-performance-and-durable-ai-agents) - [From Syntax to Singularity: AI’s Impact on Developer Roles](https://www.wearedevelopers.com/videos/900-from-syntax-to-singularity-ai-s-impact-on-developer-roles) - [From Tables to Graphs in Minutes: Supercharging Kusto Graph Analytics with AI-Powered Development](https://www.wearedevelopers.com/videos/1543-from-tables-to-graphs-in-minutes-supercharging-kusto-graph-analytics-with-ai-powered-development) ## Related Articles - [From developer to manager – what does it take to become an engineering manager?](https://www.wearedevelopers.com/magazine/42-from-developer-to-manager-what-does-it-take-to-become-an-engineering-manager) - [5 Step Guide to Managing New Job Expectations](https://www.wearedevelopers.com/magazine/343-5-step-guide-to-managing-new-job-expectations) - [Should Tech Managers Be Developers First? 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