Hybrid Utilization Management Leader (RN)

bcbsks; Topeka (KS); Hybrid; USD 116,000 - 145,000; Full time

Benefits offered by this job

Paid parental leave

Fertility assistance

401(k) match

Tuition reimbursement

Health insurance

Vision/Dental coverage

Job summary

Blue Cross and Blue Shield of Kansas seeks a Manager of Utilization Management to lead pre-service, concurrent reviews and case authorizations. You will partner with providers, vendors and internal teams to ensure evidence-based care and maintain accreditation standards.

Hybrid/onsite work option; Kansas or Missouri residency or relocation required. Manage budgets, drive quality programs (HEDIS/QRS/QIS/Stars) and serve as SME for URAC UM accreditation and Kansas Nurse Practice Act scope.

Qualifications

• Bachelor's degree in nursing or health-related field, or business.
• Active Kansas RN license required.
• Minimum 5 years Utilization Management experience.
• Leadership or management experience in a UM setting preferred.
• Willingness to travel as needed.

Responsibilities

• Lead UM operations for pre-service, predeterminations and concurrent reviews.
• Ensure compliance with regulatory and accreditation requirements.
• Apply evidence-based guidelines and drive quality initiatives (HEDIS, QRS, QIS, Stars).
• Oversee budgets and vendor relationships with accountability.
• Act as SME for URAC UM accreditation and related activities.
• Mentor UM staff and promote continuous improvement.

Skills

Medical necessity knowledge

Communication skills

Time management

Decision making

Data analysis

Vendor management

Education

BSN or health/business degree

RN license (active)

5+ years UM experience

Leadership / managed care exp

Job description

Blue Cross and Blue Shield of Kansas seeks a Manager of Utilization Management to lead pre-service, concurrent reviews and case authorizations. You will partner with providers, vendors and internal teams to ensure evidence-based care and maintain accreditation standards.

Hybrid/onsite work option; Kansas or Missouri residency or relocation required. Manage budgets, drive quality programs (HEDIS/QRS/QIS/Stars) and serve as SME for URAC UM accreditation and Kansas Nurse Practice Act scope.