RN Clinical Utilization Lead

Acentra Health; United States; On-site; USD 84,000 - 92,000; Full time

Job summary

Acentra Health in the United States seeks a Clinical Supervisor (RN) to lead utilization management initiatives, ensuring contract requirements are met while delivering high-quality clinical programs. The role focuses on maintaining standards, strengthening customer relationships, and guiding a team through complex reviews.

You will collaborate with stakeholders, oversee prior authorizations and retro reviews, and act as a subject matter expert.

Qualifications

• Active, unrestricted RN license in Indiana or a compact license.
• Associate degree or equivalent in nursing, healthcare administration, or related area.
• 2+ years of health care management experience.
• 5+ years in a lead role within quality and utilization management.

Responsibilities

• Oversee Utilization Management activities and ensure program integrity.
• Maintain high standards for clinical programs and customer relationships to meet contract requirements.
• Provide day-to-day oversight of the utilization review program, including prior authorizations.
• Serve as SME and guide leadership and cross-functional teams.
• Ensure HIPAA/privacy compliance and adherence to corporate policies.

Skills

Leadership

Communication

Team collaboration

Education

Active RN license (IN or compact)

Associate degree or related experience

Job description

Acentra Health in the United States seeks a Clinical Supervisor (RN) to lead utilization management initiatives, ensuring contract requirements are met while delivering high-quality clinical programs. The role focuses on maintaining standards, strengthening customer relationships, and guiding a team through complex reviews.

You will collaborate with stakeholders, oversee prior authorizations and retro reviews, and act as a subject matter expert.