Similar Jobs
See allUtilization Management Registered Nurse (RN)
Guidehealth
US
Registered Nurse
Utilization Review
Clinical Judgment
RN - Utilization Management
Piedmont Healthcare Corporate
US
Registered Nursing
Utilization Review
Care Management
Supervisor, Clinical Compliance (RN)
Guidehealth
US
RN
Utilization Management
Managed Care
Director of Care Coordination
WellSky
US
Clinical Nursing
Utilization Management
Prior Authorization
Registered Nurse (RN), Home Health Utilization Management
Clover Health
US
Registered Nurse
Utilization Management
Home Health
Key Responsibilities:
- Hold full accountability for UM team performance, SLAs, and quality assurance.
- Manage staffing, coaching, and professional development of UM nurses.
- Handle direct UM case reviews and provider disputes for complex cases.
Qualifications:
- Active RN license with 7+ years UM experience and 5+ years people management.
- Strong data literacy and experience with clinical decision support criteria like MCG.
- Proven ability to drive inter-rater reliability and process improvement.
Compensation and Location:
- Base salary of $115,000 annually, commensurate with experience.
- Fully remote role based in the United States.
- Not eligible for sponsorship.
IntusCare
IntusCare builds an end-to-end ecosystem for Programs of All-Inclusive Care for the Elderly (PACE) to improve care, financial performance, and compliance. As a healthcare technology company, we empower teams to improve outcomes for dual-eligible seniors.