Manager - Utilization Review Job at Acadia Healthcare (El Paso)

Utilization Management Physician Reviewer

Full-time role responsible for provisioning accurate and timely coverage determi...

Location

United States , Remote

Salary:

174070.00 - 374920.00 USD / Year

CVS Health

Expiration Date

August 21, 2026

Requirements

At least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business
Excellent verbal and written communication skills
A current, clinical, unrestricted license to practice medicine in the United States
Graduate of an accredited medical school with M.D. or D.O. Degree
3-5 years of clinical practice in a primary care setting
Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
Strong record of continuing education activities
Demonstrated understanding of culturally responsive care
Proven organizational and detail-orientation skills
US work authorization

Job Responsibility

Review service requests and document the rationale for the decision
Use evidence-based criteria and clinical reasoning to make UM determinations
Work collaboratively with the Oak Street Health Transitional Care and PCP care teams
Maintain knowledge of current CMS and MCG evidence-based guidelines
Maintain compliance with legal, regulatory and accreditation requirements
Participate in initiatives to achieve and improve UM imperatives
Assist in formal responses to health plan regarding UM process
Adhere to regulatory and accreditation requirements of payor partners
Participate in rounding and patient panel management discussions
Fulfill on-call requirement

What we offer

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources

Fulltime

Director Utilization Management

The Director of Utilization Management is a strategic clinical operations leader...

Location

United States , New York

Salary:

154600.00 - 236555.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Bachelor’s degree in healthcare, business, or a related field from an accredited institution or equivalent work experience
Progressive leadership experience in healthcare management including work experience in a mid-senior management role
Work experience and deep familiarity of health plans such as Medicare, Medicaid and/or Managed Long-Term Care Plan (MLTCP)
Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations
Work experience interpreting and operationalizing regulatory updates and guidance from DOH and CMS
Work experience demonstrating written and verbal communication skills with the ability to influence and collaborate across all levels and functions
Demonstrated success driving high performance and quality outcomes in a fast-paced, regulated environment

Job Responsibility

Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests
Develop strong operational and leadership capabilities within the organization through performance improvement, career development, and coaching
Develop and implement policies and procedures that align with industry standards, payer guidelines, and regulatory requirements
Deliver on Healthfirst’s Mission by ensuring optimum quality of member care in a cost-effective manner
Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health (DOH), and other oversight entities
Develop and monitor appropriate metrics to maintain and improve department performance
Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement
Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program, sometimes through the implementation of new technology
Serve as the operational subject matter expert on business development efforts related to UM programs, including the launch of new products or regulatory initiatives
Collaborate closely with other Operations leaders including but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Project Manager - Underground Utilities Division

General Excavating is searching for a Project Manager who is expected to manage ...

Location

United States , Omaha

Salary:

Not provided

General Excavating

Expiration Date

Until further notice

Requirements

Four (4) years minimum related experience
or equivalent combination of education and experience
Ability to read and comprehend simple instructions, short correspondence, and memos
Ability to write simple correspondence
Ability to effectively present information in one-on-one and small group situations
Ability to add, subtract multiply and divide
Ability to perform these operations using units of American money and weight measurement, volume and distance
Ability to read a tape measure and convert inches into tenths
Ability to apply common sense understanding to carry out detailed written or oral instructions
Ability to deal with problems involving multiple variables in standardized situations

Job Responsibility

Manage construction projects that generate profits for the company
Responsible for the day-to-day management of projects and on-site craft personnel and subcontractors
Directs, schedules, supervises, and coordinates activities of personnel to obtain optimum use of equipment and facilities
Provides overall management of construction project sites and procurement through final acceptance, while ensuring project safety
Maximizes profits and cost controls
Studies specifications and plans to coordinate procedures for appropriate construction methods
Studies staffing and equipment needs for each phase of construction
Procurement of materials, tools, and rental equipment
Recruiting, hiring, training, managing and mentoring employees and contractors
Directs on-site personnel engaged in planning the work procedures, executing work procedures, interpreting specifications, plans, and coordinating various phases of construction

Fulltime

Compliance Manager-Utilities

As Compliance Manager, you’ll ensure organisational adherence to regulatory, leg...

Location

United Kingdom , Warrington

Salary:

40000.00 - 52000.00 GBP / Year

Hedera Hiring Ltd

Expiration Date

Until further notice

Requirements

Excellent communication and stakeholder engagement skills
Strong understanding of UK H&S, COSHH, CDM, and environmental regulations
Skilled in risk assessment, audit management, and process improvement
Proactive mindset with strong attention to detail and organisational ability
Comfortable working in a fast-paced, multi-utility environment
NEBOSH General or Construction Certificate (minimum), Diploma or IOSH membership preferred
Minimum 3 years’ experience in a HSEQ or compliance management role within utilities (electricity, water, gas, or infrastructure)
Proven experience leading audits and investigations in regulated environments
Valid UK driving licence (multi-site travel required)

Job Responsibility

Develop and implement compliance policies aligned with electricity, water, and gas frameworks
Maintain and manage ICP accreditations and ensure full procedural compliance
Conduct internal audits, inspections, and risk assessments across multi-utility sites
Monitor regulatory changes and advise on operational impacts and updates
Lead incident investigations, track corrective actions, and ensure follow-up
Manage training programs, toolbox talks, and accreditation renewals
Maintain compliance registers, audit trails, and documentation for regulatory review
Support ISO 45001, HSQE audits, and continuous improvement initiatives

What we offer

Impactful Work: Contribute to essential infrastructure that benefits communities
Professional Growth: Opportunities for career advancement in a growing industry
Collaborative Environment: Work with motivated professionals dedicated to success
Competitive Benefits: Access to a competitive salary and benefits package

Fulltime

Physician Peer Reviewer

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a c...

Location

United States

Salary:

122907.00 - 188020.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Licensed M.D. or D.O. or D.M.D. or D.D.S.
Board Certified in a specialty recognized by the American Board of Medical Specialties
New York State Board Certified in Internal Medicine or Family Practice
Previous, relevant experience in utilization management and clinical practice
Knowledge of Medicare, Medicaid, and MLTC plans
Time management, critical thinking, communication, and problem-solving skills
Knowledge of UM//QM case philosophies and reporting requirements to state and federal agencies
Knowledge of member satisfaction//incident management and regulations
Knowledge of quality improvement methodologies
Ensures compliance to internal Healthfirst and external regulations

Job Responsibility

Assess//review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations
Render determinations in the format and within timeframes to follow Regulatory and Operational policies
Maintain productivity standards
Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases//caseload from multiple lines of businesses
Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members//internal medical departments as needed
Complete mandatory Company compliance training and training in new systems and software
Enter each day’s hours worked in Workday, on the same day
Perform other duties as assigned

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions
Paid Time Off (PTO)
Holiday pay

Parttime

Behavioral Health Medical Director

The Behavioral Health (BH) Medical Director leverages clinical expertise to prov...

Location

United States

Salary:

189600.00 - 237000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship including behavioral health environments
Current and ongoing Board Certification in psychiatry by the American Board of Psychiatry and Neurology (ABPN) required
Additional Board Certification in Child and Adolescent Psychiatry or Addiction Medicine
A current and unrestricted license in the state of California and willing to obtain additional license(s)
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
Minimum 5 years of Utilization Review or Hospital experience required
Minimum 3 years of compliance related experience preferred
Managed Care experience preferred in utilization review and case management
Expertise in behavioral health case management, utilization review and telehealth delivery
Ability to design and evaluate behavioral health programs, integrating evidence-based practices and holistic wellbeing approaches

Job Responsibility

Oversee and participate in behavioral health case management, including utilization review, telephonic care, and urgent response coordination for behavioral health and substance use disorder needs
Conduct reviews for medical necessity for prior authorization, continued stay, and post-service claims, applying medical policy, guidelines, and current research
Integrate behavioral health screening and interventions within physical health case management programs, utilizing standardized tools (e.g., PHQ2, PHQ9) and ensuring appropriate referrals
Support and monitor virtual behavioral health services, ensuring access, privacy, and continuity of care for all age groups, including children, teens, and adults
Supervise and provide clinical oversight for residential and outpatient behavioral health programs, including partial hospitalization and intensive outpatient services, with an emphasis on family engagement and comprehensive discharge planning
Lead the development and implementation of comprehensive behavioral health strategies, including program design, staff education, and quality improvement initiatives
Maintain compliance with national guidelines (e.g., MCG, InterQual, specialty college recommendations) and regulatory requirements (federal, state, ERISA) specific to behavioral health
Oversee the negotiation and implementation of cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews
Participate in grievance and appeals processes, including escalated behavioral health issues
Collaborate with the VP of Care Management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives

What we offer

Comprehensive medical and dental coverage through our own health solutions
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
Unlimited PTO policy

Parttime

Behavioral Health Medical Director

The Behavioral Health Medical Administrator (Medical Director) directs, leads, a...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology
Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.
Knowledge of managed care concepts and practices
and emerging and best practices for adult & children’s integrated care programs.
Ability to use electronic word processing, email, and electronic database resources.
Excellent customer service and oral/written communication skills

Job Responsibility

Directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.
Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management.
Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies.
Participates in aggregate and member-level clinical analyses for quality management, quality of care concerns, peer review, medical management, and utilization review processes.
Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization.
Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
Participates in credentialing, re-credentialing and competency processes for providers.
Assists care managers with care management of high risk/high-cost members.
Participates as a member or chair of internal and external committees.

Parttime

Project Manager

We are seeking an experienced Project Manager that calls for the oversight and m...

Location

United States , Central Ohio

Salary:

Not provided

Wessler Engineering

Expiration Date

Until further notice

Requirements

5-10 years’ experience in project management, preferably in the fields of government, utilities, or related technical matters, but not required
Bachelors of Science Degree, or equivalent experience
Familiarity with state or federal municipal agencies preferred but not required
Experience with business development and client relations management
Must be team oriented with good communication, planning and organizational skills
Qualified candidates must be legally authorized to be employed in the United States

Job Responsibility

Develops and maintains satisfactory relationships with clients and prospective clients as assigned
Obtains engagements from assigned clients
Prepares proposals and service contracts for clients
Coordinates man-hour budgets and fee estimates with group heads
Manages assigned projects to provide satisfactory professional services to client and to maintain satisfactory relationships with them
Serves as a professional representative of the client on matters related to the engagement
Serves as the normal channel of communications between the client and project team
Ensure that proper QA/QC reviews are completed in accordance with Company policies and procedures
Monitor and communicate project scopes
Facilitate and oversee communication, gathering of data, and project decisions with the client

Fulltime

Manager - Utilization Review

Acadia Healthcare

Location:
United States , El Paso

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 22, 2026

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