Remote Utilization Management Lead (RN)

Santa Barbara Cottage Hospital; United States; Remote; USD 98,000 - 132,000; Full time

Benefits offered by this job

Fully remote

Job summary

IntusCare is seeking a Utilization Management (UM) Manager to lead the UM nurse team supporting a PACE program. You will own end-to-end UM delivery, ensure SLA compliance, and apply clinical decision support criteria across cases to optimize care and efficiency.

The role blends hands-on UM work (approx. 25%) with 75% focused on staffing, coaching, QA, and cross-functional coordination with clients and the contracted physician, ensuring high-quality service delivery.

Qualifications

• Active RN license in good standing in the United States.
• 7+ years of utilization management experience.
• 5+ years of direct people-management experience.
• Strong data literacy and ability to use dashboards.
• Excellent written and verbal communication skills.

Responsibilities

• Lead UM team to meet all SLAs and QA benchmarks.
• Coach, hire, onboard UM nurses and develop training plans.
• Oversee individual case reviews and provider disputes.
• Collaborate with clients, physicians, and finance to resolve disputes.
• Present program performance to internal leadership and client stakeholders.

Skills

RN license

Utilization management

Team leadership

Data analytics

Communication

Education

RN license (active)

Tools

MCG guidelines

InterQual criteria

Job description

IntusCare is seeking a Utilization Management (UM) Manager to lead the UM nurse team supporting a PACE program. You will own end-to-end UM delivery, ensure SLA compliance, and apply clinical decision support criteria across cases to optimize care and efficiency.

The role blends hands-on UM work (approx. 25%) with 75% focused on staffing, coaching, QA, and cross-functional coordination with clients and the contracted physician, ensuring high-quality service delivery.