Remote Utilization Management Lead (RN)

Collab Capital; United States; On-site; USD 97,750 - 132,250; Full time

Job summary

IntusCare is seeking an RN-led Utilization Management Manager to own the UM program for a PACE-focused operation. The role includes 25% direct UM case work and 75% team leadership, coaching, and process optimization, ensuring SLA adherence and policy consistency.

The position emphasizes high-quality reviews, collaboration with IDTs and contracted physicians, and ongoing performance reporting to clients. This is a fully remote role based in the United States.

Qualifications

• Current, active RN license.
• 7+ years of utilization management experience.
• 5+ years of direct people-management experience.
• Experience with clinical decision support criteria (MCG, InterQual).
• Strong data literacy with dashboards and analytics.
• Excellent written and verbal communication skills.

Responsibilities

• Lead UM team performance to meet all SLAs and quality benchmarks.
• Oversee staffing, scheduling, workload distribution, and case assignment.
• Design QA and inter-rater reliability activities; drive process improvements.
• Direct UM case reviews and provider disputes with clinical rigor.
• Engage stakeholders across client organizations, IDTs, and medical directors.
• Present program performance to internal leadership and client teams.

Skills

RN leadership

Data analytics

Communication

Accountability

Coaching & mentoring

Process improvement

Collaboration

Education

RN license

Tools

MCG/InterQual knowledge

Job description

IntusCare is seeking an RN-led Utilization Management Manager to own the UM program for a PACE-focused operation. The role includes 25% direct UM case work and 75% team leadership, coaching, and process optimization, ensuring SLA adherence and policy consistency.

The position emphasizes high-quality reviews, collaboration with IDTs and contracted physicians, and ongoing performance reporting to clients. This is a fully remote role based in the United States.