Registered Nurse Utilization Manager

Job Summary

Managing the performance of the utilization management nurse team, the full-time Remote Registered Nurse Utilization Manager will oversee the end-to-end delivery of the UM program, ensuring compliance with service-level agreements and driving continuous improvement while also handling complex case reviews and provider disputes.

Key Responsibilities

• Accountable for UM team performance, including meeting program SLAs and conducting regular performance reviews and coaching sessions
• Lead ongoing quality assurance activities and manage staffing, scheduling, and case assignments to maintain SLA performance
• Engage with stakeholders to strengthen communication and ensure alignment on authorization decisions and care strategies

Required Qualifications

• Current, active Registered Nurse (RN) license in good standing
• 7+ years of utilization management experience, including in risk-based, integrated care models
• 3+ years of direct people-management experience leading clinical reviewers or UM nurses
• Experience with inter-rater reliability and quality assurance programs
• Strong data literacy to utilize analytics for performance improvement