Hybrid RN Leader — Utilization Management

Cambia Health Solutions; Spokane (WA); Hybride; USD 105 000 - 172 000; Plein temps

Avantages offerts par ce poste

Work-from-home options

Competitive benefits

401(k) with company match

Résumé du poste

Cambia Health Solutions in the United States is seeking a Manager of Utilization Management to lead planning, policy development and staff performance across multiple plans. The role spans prospective, concurrent and post-service reviews and requires collaboration with leaders, vendors and providers.

You will supervise a team, manage budgets, and drive program quality while shaping long-term goals for the department. This hybrid role offers relocation flexibility and a strong benefits package.

Qualifications

• Bachelor's degree in nursing or related field, masters preferred
• 5 years of clinical care experience
• 5 years of leadership experience
• 7 years of insurance industry experience or equivalent combination of education and experience
• Current unrestricted Registered Nurse (RN) Licensure, in a state or territory of the United States

Responsabilités

• Leads the development and execution of effective utilization and/or payment review management policies, procedures and standards.
• Oversees the implementation of policy updates or process improvements as needed to ensure quality and service excellence.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
• In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.
• Creates visibility and support for utilization management and/or payment review programs. Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.
• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.

Connaissances

Leadership

Clinical care

Resource management

Team leadership

Communication

Health insurance trends

Utilization management

Statistical analysis

AI tools

Formation

Bachelor's degree

RN Licensure

Masters preferred

Outils

AI tools

Description du poste

Cambia Health Solutions in the United States is seeking a Manager of Utilization Management to lead planning, policy development and staff performance across multiple plans. The role spans prospective, concurrent and post-service reviews and requires collaboration with leaders, vendors and providers.

You will supervise a team, manage budgets, and drive program quality while shaping long-term goals for the department. This hybrid role offers relocation flexibility and a strong benefits package.