Executive RN Director, Utilization Management

Texas Health Institute; Pearland (TX); Hybrid; USD 113,000 - 193,000; Full time

Benefits offered by this job

a comprehensive benefits package

incentive and recognition programs

equity stock purchase

401k contribution

Job summary

Kelsey-Seybold Clinic, part of the Optum family, is seeking a Director of Utilization Management in Texas to lead all related functions, including inpatient/outpatient reviews, regulatory reporting, and policy governance. You will drive compliance with CMS, TX DoI, NCQA, URAC, and health plan requirements.

Requires 10+ years in managed care with 5+ in management and active Texas RN license; offers a comprehensive benefits package, incentive programs, equity stock purchase, and 401k contribution.

Qualifications

• Bachelor's Degree required.
• Active Texas RN license or valid multistate compact RN license.
• 10+ years in managed care health insurance field, with 5 years in management.
• Experience analyzing complex regulations, government contract requirements, and policies.

Responsibilities

• Provide executive leadership, strategic direction, and operational oversight for Utilization Management.
• Ensure activities comply with CMS, Texas DoI, NCQA, URAC, and delegated health plans.
• Serve as subject matter expert across regulatory, policy, reporting, and audits.
• Maintain ownership of policy development, regulatory standards, and governance processes.

Skills

Regulatory compliance

Leadership

Analytical skills

Education

Bachelor's Degree

Master's degree

Job description

Kelsey-Seybold Clinic, part of the Optum family, is seeking a Director of Utilization Management in Texas to lead all related functions, including inpatient/outpatient reviews, regulatory reporting, and policy governance. You will drive compliance with CMS, TX DoI, NCQA, URAC, and health plan requirements.

Requires 10+ years in managed care with 5+ in management and active Texas RN license; offers a comprehensive benefits package, incentive programs, equity stock purchase, and 401k contribution.