Registered Nurse Utilization Manager

Job Summary

To enhance operational efficiency, the full-time Lead Utilization Management Coordinator will oversee concurrent denials, mentor team members, and act as a subject matter expert in utilization management while working remotely.

Key responsibilities

• Coaching and mentoring team members to improve skills and performance through observation and feedback
• Monitoring daily operations to ensure deadlines are met and staffing adequacy is maintained
• Acting as a liaison between the team and leadership by reporting on performance improvement and quality assurance metrics

Required qualifications

• Current Registered Nurse license issued by the state or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
• Four (4) years of clinical experience in a hospital setting
• Five (5) years of experience in Utilization Review, Clinical Appeals, or case management
• Bachelor's Degree in Nursing preferred
• Knowledge of medical terminology and third-party payers