Registered Nurse Utilization Management Lead

Job Summary

Driving operational excellence, the full-time Registered Nurse Utilization Management Lead will oversee compliance activities, implement process improvements, and collaborate with various teams to enhance departmental efficiency in a remote setting.

Key responsibilities

• Utilize process controls to achieve operational excellence and close compliance variances
• Collaborate with analytics and clinical teams to ensure regulatory content is accurately represented in data sets
• Support change management initiatives and assist in the implementation of process improvements and new business rules

Required qualifications

• Bachelor's degree in healthcare, population health, or a related field, or equivalent experience
• A minimum of five years of experience in Utilization Management or a related field
• Current, unrestricted Registered Nurse (RN) licensure is preferred
• Experience with quality control and process standards is preferred
• Six Sigma or project management certifications are preferred