Registered Nurse Utilization Manager

Job Summary

Overseeing all utilization management activities, the full-time Registered Nurse Utilization Manager will ensure consistency of services, achieve utilization targets, and maintain compliance with regulatory requirements in a remote setting.

Key responsibilities:

• Assist in the coordination and management of the pre-determination process for medical and dental services, ensuring appropriate clinical expertise in authorization decisions
• Monitor productivity and utilization trends while overseeing continuous quality improvement activities and ensuring regular audits and staff feedback
• Analyze utilization data to assess the impact on member quality of care and outcomes, formulating recommendations based on findings

Required qualifications:

• Associate's Degree in Nursing is required; Bachelor's of Science in Nursing (BSN) is preferred
• Minimum of five (5) years of clinical experience and five (5) years in case management, utilization management, or quality improvement is required
• Two years of utilization management experience is preferred
• Current, unrestricted licensure as a Registered Nurse (RN) in the state of practice is required
• Managed care experience is preferred