Nurse Utilization Management Leader

University Health Careers; Pleasanton (TX); On-site; USD 110,000 - 150,000; Full time

Job summary

University Health Careers seeks an experienced nursing leader to head Utilization Management, ensuring accreditation readiness, regulatory compliance, and performance improvement across UM programs.

You will supervise UM staff, oversee prior authorization, concurrent and retrospective reviews, and maintain medical necessity criteria while collaborating with Medical Directors and care teams. An RN license in Texas and five years UM experience are required.

Qualifications

• Graduate of an accredited school of professional nursing.
• Bachelor's degree in Nursing (BSN).
• Master's degree preferred.
• RN license in Texas (unrestricted) required; national certification desirable.

Responsibilities

• Provide strategic leadership for Utilization Management programs and initiatives.
• Oversee accreditation readiness, regulatory compliance, and performance improvement planning.
• Lead UM staff and oversee prior authorization, concurrent, retrospective reviews, and appeals.
• Collaborate with Medical Directors, Care Management, Compliance, and Quality Management to ensure appropriate resource use.

Skills

Strategic leadership

Regulatory compliance

Performance improvement

Stakeholder liaison

Education

BSN

MSN or related master's preferred

Accredited nursing program

Job description

University Health Careers seeks an experienced nursing leader to head Utilization Management, ensuring accreditation readiness, regulatory compliance, and performance improvement across UM programs.

You will supervise UM staff, oversee prior authorization, concurrent and retrospective reviews, and maintain medical necessity criteria while collaborating with Medical Directors and care teams. An RN license in Texas and five years UM experience are required.