Remote Utilization Management Leader (RN)

Collab Capital; Northern (KY); Hybrid; USD 98,000 - 132,000; Full time

Job summary

IntusCare is seeking an experienced Utilization Management Manager, an RN who will own the UM program end-to-end for a PACE client. You will oversee a team of UM nurses, ensure policy compliance, and drive continuous improvement in decision support and service quality.

In this remote role, you will balance 25% case work with 75% leadership duties, delivering performance reporting and coordinating with the contracted physician to maintain high-quality service for dual-eligible seniors.

Qualifications

• Current, active RN license in good standing.
• 7+ years in utilization management.
• 5+ years of direct people-management experience.
• Experience owning QA programs and inter-rater reliability.
• Strong data literacy and ability to use dashboards for performance diagnostics.
• Excellent written and verbal communication with execs and clients.

Responsibilities

• Own end-to-end UM program delivery, meeting all SLAs.
• Lead performance management, coaching, and staffing for UM nurses.
• Ensure consistent use of PACE authorization policies and criteria.
• Develop QA and reliability activities to reduce variance in decisions.
• Manage case assignments and coverage during volume shifts and PTO.
• Lead provider dispute processes and collaborate with medical directors.

Skills

RN license

Utilization management

People management

Data analytics

Clinical communication

Education

Registered Nurse (RN) license

Tools

MCG

InterQual

Job description

IntusCare is seeking an experienced Utilization Management Manager, an RN who will own the UM program end-to-end for a PACE client. You will oversee a team of UM nurses, ensure policy compliance, and drive continuous improvement in decision support and service quality.

In this remote role, you will balance 25% case work with 75% leadership duties, delivering performance reporting and coordinating with the contracted physician to maintain high-quality service for dual-eligible seniors.