RN Utilization Review Manager

Job Summary

RN Utilization Review Manager, responsible for overseeing the daily operations of Utilization Management staff in a full-time, salaried position, including team management, performance monitoring, and compliance with regulatory standards.

Key Responsibilities

• Supervise and manage the Utilization Management team, including scheduling and performance evaluations
• Ensure compliance with documentation standards and participate in audits for regulatory readiness
• Analyze operational data to drive performance improvements and resolve issues collaboratively

Required Qualifications, Training, and Education

• Current, unrestricted RN license in the United States or U.S. territory
• Graduate of an accredited nursing program (ADN or diploma required; BSN preferred)
• 1-2 years of experience in care management or utilization management
• 1+ year of informal leadership experience or direct management experience preferred
• Knowledge of medical claims and coding (ICD-10, CPT, HCPCS) is essential