Hybrid RN Utilization Management Leader

Cambia Health; Vancouver (WA); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

Commute and parking benefits

Health benefits

Job summary

Cambia Health is seeking a Manager of Utilization Management to lead clinicians and staff across multiple plans. This hybrid role combines on-site leadership with remote collaboration to optimize prospective, concurrent, retrospective review and bill audit processes.

You will supervise 10-15 FTEs, set performance standards, manage budgets, and partner with executives to align goals. A RN with clinical leadership and insurance experience is required, and relocation or commuting arrangements are

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

Responsibilities

• 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.
• Develops supervisors and participates in talent management activities.
• Regularly communicates organizational objectives and team goals.
• Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
• Collaborates with other leaders and across departments to resolve issues.
• 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.
• May develop and present educational updates to other departments.
• Oversees development and implementation of department programs.
• Responsible for program quality and successful outcomes of programs.
• As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.

Skills

Issue identification and problem Solv.

Resource & project management

Team leadership & development

Effective communication

Health insurance industry knowledge

Clinical case management

Statistics in UM programs

AI tools in professional settings

Education

Bachelor's degree in nursing or related field

Masters preferred

Job description

Cambia Health is seeking a Manager of Utilization Management to lead clinicians and staff across multiple plans. This hybrid role combines on-site leadership with remote collaboration to optimize prospective, concurrent, retrospective review and bill audit processes.

You will supervise 10-15 FTEs, set performance standards, manage budgets, and partner with executives to align goals. A RN with clinical leadership and insurance experience is required, and relocation or commuting arrangements are