12 Utilization Management Jobs

Position Overview We are seeking a skilled and dedicated MongoDB Atlas Administrator to join our dynamic team in Chennai. This full-time position offers an exciting opportunity to work with cutting-edge technology in a collaborative environment. The ideal candidate will have a strong background in database management and a passion for optimizing performance and ensuring data integrity. With an annual salary of 10,00,000, this role is perfect for professionals looking to advance their careers in database administration. Key Responsibilities As a MongoDB Atlas Administrator, you will be responsible for a variety of tasks that are crucial to the smooth operation of our database systems. Your key responsibilities will include: Managing and monitoring MongoDB Atlas environments to ensure optimal performance and availability. Implementing and maintaining reporting systems to track database utilization and performance metrics. Conducting log management to identify and resolve issues proactively. Writing and optimizing complex queries to support application development and data analysis. Utilizing Atlas AJAX for efficient database management and operations. Collaborating with development teams to ensure seamless integration of MongoDB with applications. Providing support and training to team members on best practices for MongoDB usage. Qualifications The ideal candidate will possess the following qualifications: A minimum of 5 to 7 years of experience in database administration, specifically with MongoDB. Strong understanding of MongoDB Atlas and its features. Proficiency in reporting, utilization management, and log management. Experience with writing and optimizing queries for performance. Familiarity with Atlas AJAX and its application in database management. Excellent problem-solving skills and attention to detail. Strong communication and collaboration skills to work effectively within a team. If you are a motivated professional looking to make a significant impact in a growing organization, we encourage you to apply for this exciting opportunity. Join us in shaping the future of our database management practices!

As a valued member of the Infosys delivery team, you will be responsible for collaborating with clients to resolve quality assurance issues and ensuring their utmost satisfaction. Your key duties will include comprehending requirements, designing and reviewing solutions, validating architectures, and delivering top-notch service offerings in the technology sector. Furthermore, you will play a crucial role in project estimation, contribute to solution delivery, conduct technical risk assessments, oversee code reviews and unit test plan evaluations. Your leadership will be instrumental in guiding your teams towards creating optimized, high-quality code deliverables, promoting continuous knowledge enhancement, and ensuring adherence to organizational protocols and standards. Your expertise will be pivotal in developing efficient programs and systems that cater to the needs of our clients, aiding them in their digital transformation journey. If you possess the necessary skills and passion to drive our clients towards success in the digital realm, this opportunity is tailor-made for you. In terms of technical requirements, we are seeking individuals with domain experience in clinical RCM, pharmacy benefit management, healthcare business analysis with Agile and Safe Agile experience, as well as expertise in Medicaid and FHIR HL7 data analysis. Additionally, familiarity with healthcare digital transformation, cloud data solutions design, data analysis, analytics, and RPA solution design will be highly advantageous. If you are equipped with the aforementioned skills and are enthusiastic about contributing to the digital evolution of healthcare, this role presents an exciting opportunity for you to make a meaningful impact.,

The Resource Management Manager role involves overseeing resource planning, allocation, and utilization within the Organization. Your responsibilities include ensuring that resources are assigned to projects at the right time, balancing workload distribution, optimizing capacity, and supporting business objectives. You will collaborate with Directors, Project Managers, external stakeholders, and HR to maintain workforce efficiency, track skills, plan skill upgrades, project allocations, and anticipate future resource needs. You will lead the workforce planning process and demand intake process to achieve optimal resource allocation across projects and teams. Working closely with delivery directors and managers, you will prioritize assignments and maintain a centralized system to track availability, skills, and project assignments. Monitoring resource utilization and workload distribution, you will identify gaps and recommend solutions like hiring, upskilling, or reallocation. You are responsible for maintaining an up-to-date database of employee skills, certifications, and expertise, actively managing resources in the Bench, and planning upskilling initiatives. Acting as a liaison between Directors, Project Managers, and HR, you will align resourcing strategies with business goals, participate in workforce planning discussions, and contribute to hiring decisions. You will develop and implement best practices for resource management, establish governance frameworks and policies, and continuously assess and improve resource management tools and methodologies. Your success will be measured by efficient resource allocation, high resource utilization rates, reduction in skill gaps, and positive feedback from stakeholders. To be successful in this role, you should have a Bachelor's degree in IT or Business, 10+ years of experience in account management, resource management, workforce planning, and IT project management. Proficiency in resource management tools, strong understanding of IT project lifecycle and methodologies, excellent analytical and problem-solving skills, and strong stakeholder management and communication abilities are required. Certification in resource management, project management, or Agile methodologies is preferred. This is a permanent full-time position based in Bangalore, offering competitive salaries, comprehensive health benefits, flexible work hours, remote work options, professional development, and training opportunities in a supportive and inclusive work environment.,

The RMO Manager is responsible for designing, building, and managing the end-to-end talent demand and supply management process to ensure timely talent fulfillment, maximize revenue realization, and drive operational efficiency. This role entails close collaboration with Commercial, Delivery, HR & Talent Acquisition, and Finance teams to align workforce strategies with business objectives. The key aspects of this role include data-driven decision-making, demand forecasting, capacity planning, bench management, utilization improvement, process standardization, and team leadership to enhance operational excellence across the organization. Responsibilities Talent Demand & Supply Management: - Develop and manage demand forecasting & planning for a rolling 12-month estimate of headcount needs. - Align talent fulfillment strategies with business objectives to optimize revenue realization. - Optimize internal fulfillment (bench and project release) and external hiring in coordination with Talent Acquisition. Resource Utilization & Workforce Planning: - Monitor and enhance utilization targeting 85%+ for offshore and 95%+ for onsite resources. - Drive bench management strategies for optimal resource deployment and cost efficiency. - Develop data-driven capacity planning based on skills, levels, and locations to support business growth. Process & Policy Development: - Design and implement best practices for efficient resource deployment, utilization, and workforce management. - Ensure compliance with internal workforce policies and industry best practices. - Standardize and automate processes in collaboration with IT to enhance efficiency and accuracy. Collaboration & Stakeholder Management: - Engage with leadership teams across Commercial, Delivery, HR, Talent Acquisition, and Finance to align workforce strategies. - Partner with IT & automation teams to implement tools that enhance RMO process efficiency. - Prepare and present workforce analytics, KPIs, and insights to business leadership for informed decision-making. Leadership & Team Development: - Define the vision and charter for the RMO team to foster a high-performance culture. - Lead, mentor, and develop a team of RMO analysts, setting clear career roadmaps and performance goals. - Encourage a customer-centric and data-driven approach within the RMO team to effectively support business needs. Qualifications: - Bachelor's degree with 14-18 years of experience in resource/workforce management, operations, or talent planning within IT or professional services. - Strong understanding of workforce planning, talent forecasting, utilization management, and operational excellence. - Experience in implementing industry best practices in workforce management, ensuring policy compliance and efficiency. - Excellent analytical and decision-making skills, with expertise in data-driven resource planning. - Strong stakeholder management skills, with the ability to collaborate across multiple business units. - Proficiency in automation and workforce management tools to enhance operational efficiency. - Highly self-motivated, adaptable, and results-driven in a dynamic business environment. - Excellent communication, negotiation, and leadership abilities to drive process improvements and strategic decision-making. About Us: Bristlecone is the leading provider of AI-powered application transformation services for the connected supply chain. We empower our customers with speed, visibility, automation, and resiliency to thrive on change. Our transformative solutions in Digital Logistics, Cognitive Manufacturing, Autonomous Planning, Smart Procurement, and Digitalization are positioned around key industry pillars and delivered through a comprehensive portfolio of services spanning digital strategy, design and build, and implementation across a range of technology platforms. Bristlecone is ranked among the top ten leaders in supply chain services by Gartner. We are headquartered in San Jose, California, with locations across North America, Europe, and Asia, and over 2,500 consultants. Bristlecone is part of the $19.4 billion Mahindra Group. Equal Opportunity Employer Information Security Responsibilities: - Understand and adhere to Information Security policies, guidelines, and procedures for the protection of organizational data and Information System. - Participate in information security training and act while handling information. - Report all suspected security and policy breaches to the InfoSec team or appropriate authority (CISO). - Understand and adhere to the additional information security responsibilities as part of the assigned job role.,

As a Registered Nurse (RN) with active, unrestricted license in [state], your primary responsibility will be to review and assess clinical information submitted with Prior Authorization (PA) requests to determine medical necessity, appropriateness, and benefit coverage. You will conduct clinical evaluations for outpatient, inpatient, and specialty services, including J-code medications and durable medical equipment (DME) as applicable. It will be essential for you to apply CMS Medicare Advantage guidelines, internal policies, and clinical criteria (such as MCG/InterQual) to make informed decisions. Collaboration will be a key aspect of your role as you work closely with physicians, pharmacists, Utilization Management (UM) staff, and external providers to ensure accurate and timely resolution of cases. In situations involving complex or borderline cases, you will be required to escalate them to Medical Directors for a final determination. Your ability to document decisions, rationale, and communications clearly and accurately in the clinical system of record will be crucial. You will also be expected to provide support for audits, appeals, and compliance-related documentation requests, as well as participate in quality improvement initiatives and workflow optimization. Educating providers and internal teams on medical policy, coverage criteria, and regulatory requirements will be part of your regular responsibilities. To be successful in this role, you should have a minimum of 3 years of clinical experience in Utilization Management, Prior Authorization, Case Review, or related fields, along with at least 2 years of direct experience working with Medicare Advantage plans and understanding CMS requirements. Familiarity with medical management software and PA platforms, such as GuidingCare, TruCare, Epic, or similar, will be advantageous. A working knowledge of MCG/InterQual guidelines and CMS NCD/LCDs is also required. Your excellent clinical decision-making, documentation, and communication skills will be critical in this position. The ability to work independently and efficiently manage high case volumes in a fast-paced environment is essential for success. This is a full-time position with a day shift schedule. The work location is in person, and the job type is Full-time. The required experience includes 2 years of CMS Requirements and 3 years of Clinical experience.,

Role & responsibilities Come join our team! Help us tackle the data usability challenge for payers. Your expertise and experience will help drive meaningful performance outcomes. You'll also have the chance to advance your career, acquire new skills, and collaborate with some of the most innovative minds in payer data management. We are seeking an experienced Business Analyst with Utilization Management and Care Management subject matter expertise to join our growing team. You will act as a liaison between business stakeholders, the data modeling team, and technical teams, ensuring client needs and business requirements are translated into actionable technical specifications resulting in seamless data exchange and efficient data integration between formats and systems. You will contribute expertise and experience in both analytic and operational components of utilization management and care management. Within utilization management, your experience in payer-focused utilization review processes in clinical and/or pharmacy context, including prior authorization, concurrent review, appeals/denials, regulatory compliance, and with data analysis will help shape the product. Within care management, deep understanding of care management operations and plans, program evaluation, data analysis and interpretation (claims, authorizations, case management,, and member engagement will also help shape the product. Finally, demonstrated expertise in data mapping and transformation and technical requirements gathering and analysis will help optimize client implementations and develop client-facing solutions that drive business value for payers in critical programs surrounding utilization and care management, including the interplay between this area and Value Based Care, Population Health, CMS Interoperability, and Quality. You Will Be Responsible for: Requirements Gathering and Analysis . Define, analyze, and document detailed functional and technical requirements for specific data solutions. Tasks may include collecting requirements from internal SMEs, partnering closely with Client Delivery and/or Customers to gather and refine technical and business requirements, developing and reviewing QA/user acceptance testing criteria, and business systems analysis, including data and gap analyses. Stakeholder coordination/collaboration : Be a knowledgeable bridge between clients, product management, data modeling, SMEs, and other team members to define, document and share detailed functional and technical requirements and expected impact using all of the tool in your technical BA toolkit. Mock-ups/Prototyping : Create mocks-ups, sample reports, and/or output tables to help visualize and communicate requirements, workflows, and expected results, based on client problems to be solved, business rules, and technical requirements. User Acceptance Testing/QA Process . Collaborate with key stakeholders to define user stories, test cases, QA/User acceptance testing criteria for data solutions. Partnering with Agile Scrum Teams : Participate in relevant agile ceremonies, build user stories according to requirements, and help define test cases and acceptance criteria. Solution Maintenance . Co-own maintenance and create of artifacts that includes but is not limited to document portal/repository, workflows/diagrams, data mapping and technical requirements documents, analytics/business logic, user stories, and UAT scenarios and test cases. Continual Learning . Keep up to date on latest industry trends in how payers are using data to drive improvement in outcomes. Leverage this expertise to continue to refine how solutions are developed and refined to maximize value for clients. Must-Have Qualifications: Deep understanding of how US Health Insurers (payers) utilization management and care management programs clinical and pharmacy, including prior authorization processes, workflows, regulatory compliance, data analysis and interpretation (claims, authorizations, case management), and member engagement 5+ years of experience working with US healthcare data (claims, clinical, member, provider, CMS files, etc.) and standards (e.g., HL7, FHIR, EDI, CDA) and integration 5+ years of progressive experience in business requirements management (definition, documentation, mock-ups, data analysis) 3+ years experience participating in UAT process management – test case planning and scenarios, writing UAT acceptance criteria, UAT test case execution, tracking and resolving defects, and UAT closure Proficiency in data mapping and data exchange protocols (e.g., API, JSON, XML) related to health information systems. Proficiency in SQL, Python, and/or other programming languages for data extraction and transformation. Working knowledge of UM and Care Management systems of record Strong communicator who can share domain expertise effectively across multiple departments from Sales, Client Delivery, Product, Engineering, and Information Security "Roll up your sleeves mentality" working side-by-side with your team. Self-starter with demonstrated ability to drive workstreams independently and manage risks with strong compass on when to escalate issues. Demonstrated ability to thrive in a fast-paced, dynamic startup environment. Nice-to-Have Qualifications: Working knowledge of US healthcare (one or more) - health insurance markets, government sponsored health plans (Medicare/Medicaid), and/or care delivery and reimbursement models (e.g. VBC, population health, risk adjustment) Familiarity with cloud platforms (e.g., AWS, Azure, Databricks, Snowflake, etc.) for hosting healthcare applications and data storage. Experience with EHRs and/or HIEs and healthcare data workflows. Experience with healthcare analytics and data visualization tools (e.g., Power BI, Tableau) Experience with Agile methodologies in healthcare technology projects. Interest in Advanced Analytics, Data Science, and/or GenAi Preferred candidate profile

Profile Overview:We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles run as per expectations. Maintain diesel stores and track the usage of diesel on a regular basis. Ensure that there is no theft. Helping the subcontractors with gate passes and weighbridge processes. Assisting the team in engaging and monitoring the quantum of bulkers from cement plants and brick plants to enhance the sale/disposal of Silo Ash. Manage good relationships with cement companies and mine owners for their short-term and long-term business needs. Engage with all the sub-contractors and manage the driver requirements. Coordinate with thermal power plants and ensure engagement by maintaining rapport and relationships for further business. Assisting the team in managing all administrative activities and official activities thereby maintaining safe disposal of ash disposal Assisting the team in building the operational team. Need to assist the management or head with any other possible new business opportunities in current locations. Desired Profile Any graduate with 10 to 20 years of experience in FLY ash disposal and management. Should have good understating of transportation and fleet management. Should handle a team of 15 to 20 supervisors Ability to handle the work load and multiple trips Should have a good understanding of managing the ash business and logistics. Should have good negotiation and organizational skills Location - Tiroda, Darlipali, Chennai, Bilaspur,Banjhidih, Jharkhand, Bokaro, Nellore, Karnataka, Kadapa, Vizag

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles run as per expectations. Maintain diesel stores and track the usage of diesel on a regular basis. Ensure that there is no theft. Helping the subcontractors with gate passes and weighbridge processes. Assisting the team in engaging and monitoring the quantum of bulkers from cement plants and brick plants to enhance the sale/disposal of Silo Ash. Manage good relationships with cement companies and mine owners for their short-term and long-term business needs. Engage with all the sub-contractors and manage the driver requirements. Coordinate with thermal power plants and ensure engagement by maintaining rapport and relationships for further business. Assisting the team in managing all administrative activities and official activities thereby maintaining safe disposal of ash disposal Assisting the team in building the operational team. Need to assist the management or head with any other possible new business opportunities in current locations. Desired Profile Any graduate with 10 to 20 years of experience in FLY ash disposal and management. Should have good understating of transportation and fleet management. Should handle a team of 15 to 20 supervisors Ability to handle the work load and multiple trips Should have a good understanding of managing the ash business and logistics. Should have good negotiation and organizational skills

Responsibilities: * Loading of FLYASH from silo or dykash * Unloading of flyash in mines or highways* Trip or fleet management * Daily trip management of vehicles* Responsible to handle smooth operations of ash discharge* Responsible to handle smooth fleet operations, loading and unloading of ash in vehicles.* Proper planning of manpower as and when required.* Loading of ash from the silo to Hywa, dumpers and assigning bills.* Handle contractors and vendors for smooth ash disposal from the sites. * Operate the ash unloading equipment and drive the ash-hauling trucks to dispose of the coal ash. Desired Profile:* Any graduate with 1 to 8 yrs of experience in FLY ash management.* Excellent relationship with Operations, Logistics, Thermal power plants, Bricks and Cement manufacturers* Should have good understanding of managing the FLY ASH business* Willing to travel* Should have good negotiation skills Location - Nellore, Vizag, Kadapa, Tamil Nadu, Chennai, Mumbai, Madhya Pradesh, Uttar Pradesh, Karnataka, Andhra, Telangana, Chhattisgarh, Raipur, Bhilai, Raigarh, Odisha, Rajasthan, Tiroda, Khandwa, Banjhidih, Simhadri Raichur

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles run as per expectations. Maintain diesel stores and track the usage of diesel on a regular basis. Ensure that there is no theft. Helping the subcontractors with gate passes and weighbridge processes. Assisting the team in engaging and monitoring the quantum of bulkers from cement plants and brick plants to enhance the sale/disposal of Silo Ash. Manage good relationships with cement companies and mine owners for their short-term and long-term business needs. Engage with all the sub-contractors and manage the driver requirements. Coordinate with thermal power plants and ensure engagement by maintaining rapport and relationships for further business. Assisting the team in managing all administrative activities and official activities thereby maintaining safe disposal of ash disposal Assisting the team in building the operational team. Need to assist the management or head with any other possible new business opportunities in current locations. Desired Profile Any graduate with 10 to 20 years of experience in FLY ash disposal and management. Should have good understating of transportation and fleet management. Should handle a team of 15 to 20 supervisors Ability to handle the work load and multiple trips Should have a good understanding of managing the ash business and logistics. Should have good negotiation and organizational skills Keyword Utilization Management,fleet management,transportation management,Fly Ash Disposal*

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles run as per expectations. Maintain diesel stores and track the usage of diesel on a regular basis. Ensure that there is no theft. Helping the subcontractors with gate passes and weighbridge processes. Assisting the team in engaging and monitoring the quantum of bulkers from cement plants and brick plants to enhance the sale/disposal of Silo Ash. Manage good relationships with cement companies and mine owners for their short-term and long-term business needs. Engage with all the sub-contractors and manage the driver requirements. Coordinate with thermal power plants and ensure engagement by maintaining rapport and relationships for further business. Assisting the team in managing all administrative activities and official activities thereby maintaining safe disposal of ash disposal Assisting the team in building the operational team. Need to assist the management or head with any other possible new business opportunities in current locations. Desired Profile Any graduate with 10 to 20 years of experience in FLY ash disposal and management. Should have good understating of transportation and fleet management. Should handle a team of 15 to 20 supervisors Ability to handle the work load and multiple trips Should have a good understanding of managing the ash business and logistics. Should have good negotiation and organizational skills

Role & responsibilities We are seeking a dedicated Utilization Management Specialist to join our Chennai office. In this role, you will be responsible for reviewing and analyzing clinical information to determine the medical necessity and appropriateness of healthcare services, ensuring compliance with established guidelines and policies. Your expertise will contribute to optimizing patient care and resource utilization. Key Responsibilities Conduct prior authorization, concurrent, and retrospective reviews for various healthcare services, including inpatient, outpatient, home health, and behavioral health. Apply evidence-based criteria (e.g., MCG, InterQual) to assess the necessity of medical services. Collaborate with healthcare providers, medical directors, and clinical staff to facilitate appropriate care plans and resource utilization. Maintain accurate and organized documentation of all utilization management activities. Participate in quality improvement initiatives and assist in developing clinical guidelines. Monitor and report on utilization trends to management, identifying areas for improvement. Educational qualifications and Experience : Bachelor's Degree in Nursing (BSc Nursing) or equivalent. Minimum of 2 years of clinical experience in a hospital or healthcare setting. Active and unrestricted Registered Nurse (RN) license in the United States. Familiarity with utilization management processes and guidelines (e.g., MCG, InterQual). Proficient in medical terminology, anatomy, and physiology. Strong analytical and problem-solving skills. Excellent communication skills, both written and verbal. Proficient in Microsoft Office applications. Preferred candidate profile Preferred Qualifications Experience with Medicaid, Medicare, and Managed Care programs. Previous experience in utilization review or case management. Certification in Case Management (CCM) or Accredited Case Manager (ACM) is a plus