Manager Registered Nurse - Utilization Management
Core
Lead a team to oversee care coordination, utilization review, and regulatory compliance to ensure patients receive appropriate care at the right time.
Role type
Manager, Utilization Management
Builds
Care coordination programs, utilization review decisions, and compliance initiatives
Domain
Healthcare administration / Insurance utilization management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization Management experience, Case Management experience, CMS/Medicare/Medicaid regulation knowledge, Cross-functional team leadership, Denials and appeals resolution, Data analysis for trends and improvement, Budget monitoring, Staff recruitment and development
Preferred skills
Continuous improvement mindset, Change management, Stakeholder partnership
Technologies
None stated
Responsibilities
Oversee department operations including referrals, medical necessity reviews, and application of medical policies; Ensure quality and accuracy of UM review decisions; Participate in policy development and regulatory compliance; Monitor staffing, productivity, and budget; Meet performance metrics; Represent UM on committees; Recruit, engage, develop, and manage staff
Seniority
Manager, hands-on leadership
