Remote Utilization Management Lead (RN)

IntusCare; United States; On-site; USD 103,500 - 126,500; Full time

Job summary

IntusCare is seeking an experienced Utilization Management (UM) Manager to lead a team of UM nurses supporting PACE programs. You will own end-to-end UM delivery, ensuring SLAs, policy adherence, and continuous improvement across the UM function.

The role balances direct UM case work (approximately 25%) with 75% focusing on coaching, staffing, and cross-functional collaboration with client teams and the Director of Clinical Operations. Remote based in the United States.

Qualifications

• Active RN license in good standing.
• 7+ years in utilization management, including risk-based, integrated care.
• 5+ years of direct people-management leading clinical reviewers.
• Experience improving inter-rater reliability and QA programs.
• Strong data literacy and ability to work with dashboards.
• Excellent written and verbal communication for executive audiences.

Responsibilities

• Own UM program performance and meet all SLAs.
• Lead QA, monitor metrics, and coach the team.
• Apply policies and decision criteria across all cases.
• Manage staffing, scheduling, and workload to sustain SLA.
• Develop training programs for new UM nurses.
• Partner with physicians and client leaders to ensure high-quality service.
• Prepare program performance reports for leadership.

Skills

Utilization management

Leadership

Data literacy

Communication

Clinical decision support

Job description

IntusCare is seeking an experienced Utilization Management (UM) Manager to lead a team of UM nurses supporting PACE programs. You will own end-to-end UM delivery, ensuring SLAs, policy adherence, and continuous improvement across the UM function.

The role balances direct UM case work (approximately 25%) with 75% focusing on coaching, staffing, and cross-functional collaboration with client teams and the Director of Clinical Operations. Remote based in the United States.