Milliman Utilization Review Jobs in Usa

Identifies Community First Health Plan members with specific health care needs and provides case management interventions.

Analyzes, approves health care services and monitors outpatient care planning for Community First Health Plans members based on established criteria, plan policies and procedures.

Formulates and communicates case management plans that efficiently utilize health care services to move the member along the continuum of care towards optimum outcomes in the safest, most cost effective manner.

Graduation from an accredited school of professional nursing is required, BSN preferred.

Master's degree is preferred.

Minimum three years' acute care experience or managed care experience is required.

Minimum one-year of concurrent review experience is required.

Candidate must have utilization management and/or quality assurance experience.

Basic knowledge of Medicaid, community resources and alternate funding programs is desired.

Knowledge of InterQual screening criteria as well as DRG, ICD-9 and CPT coding is preferred.

Current Registered Nurse license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) designation is preferred.

Title: Utility Construction Project Manager

Role: Full time travelling to project sites

Base Salary:125-150K based on experience

Job Summary

Project Managers are responsible for managing assigned construction projects. Project Managers serve as the primary contact with owners/clients and must continually foster a positive relationship with all parties involved. Project Managers generate and monitor cost estimates, prime contracts, schedules, subcontracts, and owner as well as subcontractor change orders, RFI’s, and process submittals.

Essential Duties and Responsibilities

• Work alongside Division Managers, Superintendents, and Foremen to plan, organize, and direct activities in conjunction with road and site construction project plans

• Coordinate total cost estimates for a particular bid/project as assigned

• Check bid source files to ensure the latest information is available prior to bid day

• Reviews proposal specifications and drawings and attends pre-bid meetings

• Generates RFI’s necessary to establish a competitive baseline

• Performs material take-offs and mathematical calculations accurately

• Determines the type of materials, equipment, labor, and subcontractors required

• Monitor and control projects through administrative direction of on-site foremen to ensure the

project is completed on schedule and within budget

• Represent the company in project meetings and attend strategy meetings

• Work with the contract administrator to manage financial aspects of contracts, protecting the

company’s interest and simultaneously maintaining a good relationship with the customer

• Interpret and explain plans and contract terms to administrative staff, workers, and clients

• Upholds all company safety practices and wears appropriate PPE when working in the field

• Formulate reports concerning such areas as work progress, costs, and scheduling

• Other related duties and projects as assigned

Key Job Requirements

• Bachelor’s degree in Construction Management, Engineering, or another related major

• Experience working on PG&E projects is highly desired

• 5+ Years of utility construction project management

• Ability to estimate projects and develop cost proposals

• Strong time management and prioritizing abilities

• Strong written & verbal communications skills

• Ability to read and understand drawings and specifications

• Strong computer skills and proficiency in Microsoft Office programs, including Microsoft Project &

Excel

• Ability to demonstrate team building, leadership, and mentoring skills

• Travel requirements to job sites

o Must be able to maintain a valid driver's license if travelling

Company Description

Gator Grading & Paving, LLC is a Palmetto, FL–based contractor serving Manatee, Sarasota, Hillsborough, Pinellas, DeSoto, Polk, Charlotte, and Pasco counties. Founded in 2007, Gator specializes in roadway, residential, commercial, and municipal site construction. Our management team brings over 200 years of combined experience and has contributed to more than 20 award‑winning projects. We are committed to delivering efficient, high‑quality work for both new and returning clients, supported by a skilled team dedicated to safety, performance, and customer satisfaction.

Role Description

This is a full-time on-site role for an Underground Utilities Project Manager located in Palmetto, FL. The role involves managing projects from planning to completion, coordinating logistics, ensuring project timelines are met, and adhering to quality standards. Responsibilities include overseeing inspections, managing budgets, and maintaining clear communication with clients, vendors, and subcontractors to ensure project success.

Qualifications

• Strong skills in Project Management, including planning, scheduling, and overseeing construction projects
• Hands-on experience with Expediting and Logistics Management
• Proficiency in performing and supervising Inspections to ensure project compliance with standards and regulations
• Experience as an Expeditor in managing supply chain tasks and ensuring timely delivery
• Familiarity with underground utility construction processes and safety practices
• Effective communication, leadership, and problem-solving skills
• Ability to manage budgets and handle project documentation efficiently

Experience & Education Requirements

• High school diploma or equivalent required; college degree highly desirable
• 5+ years of progressive experience in civil engineering design, construction, paving, or land development project management
• Experience managing both public and private sector projects
• Strong familiarity with DOT specifications and compliance requirements
• Degree in civil engineering or related field preferred, or an equivalent combination of training and experience
• Proven ability to oversee complex project scopes, ensure quality and safety, and deliver projects on time and within budget

Essential Job Requirements

• Manage all phases of complex projects from initiation through completion
• Communicate effectively with project owners, vendors, and subcontractors
• Negotiate, prepare, and administer subcontractor and vendor contracts
• Review, validate, and approve subcontractor and vendor invoices
• Coordinate closely with jobsite superintendents while maintaining strong client relationships
• Conduct in‑depth project reviews to schedule deliverables, estimate costs, and ensure contractual compliance
• Issue purchase orders and subcontracts; secure necessary permits and licenses
• Oversee project scheduling, invoicing, change orders, estimating, and takeoffs
• Perform daily monitoring and documentation of job progress
• Proactively plan to prevent issues and resolve problems as they arise
• Analyze, manage, and mitigate project risks
• Ensure adherence to quality construction standards and proper techniques
• Prepare internal and external project status and performance reports

Junior Estimator

Austin, TX | Up to $90k Base + Bonus + Benefits

A growing self-performing heavy civil contractor in Austin is hiring a Junior Estimator to support their underground utility bids. This is a great opportunity for someone who wants training, mentorship, and a long-term path in estimating. It’s a genuinely solid culture. People get along, they help each other out, and leadership is involved without micromanaging. If you work hard and take ownership, you’ll fit right in.

Possible backgrounds:

• 1–3 years in construction and looking to move into estimating
• Takeoff/quantity experience at a Heavy Civil Contractor

What you’ll be doing:

• Quantity takeoffs + assisting with bids (Underground Utilities)
• Reviewing plans/specs and helping build pricing
• Gathering supplier/subcontractor quotes and supporting bid submissions

What you’ll need:

• Previous experience reading construction plans and doing takeoffs.
• Detail-oriented, confident with numbers
• Comfortable in CAD or a takeoff software (AgTek, TBC, Bluebeam Revu, InSite etc.)
• Strong attitude and eagerness to learn

Junior Estimator

Austin, TX | Up to $90k Base + Bonus + Benefits

The challenges of affordable healthcare continue to create new opportunities.

Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.

These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.