RN Director, Utilization Management & Compliance

UnitedHealth Group; Pearland (TX); On-site; Confidential; Full time

Benefits offered by this job

Comprehensive benefits

Incentives and recognition programs

Equity stock purchase

401k

Job summary

UnitedHealth Group seeks a Director of Utilization Management to lead executive oversight of inpatient and outpatient utilization review, prior authorization, and regulatory reporting across multiple sites in Texas. You will ensure policies meet CMS, state, and accreditation requirements while guiding clinical and administrative teams.

The role emphasizes strategic direction, policy development, and collaboration with health plans to optimize quality and cost outcomes.

Qualifications

• Bachelor's degree required.
• Active Texas RN license or valid multistate compact RN license.
• 10+ years in managed care health insurance, with 5 years in management.
• Experience analyzing complex regulations, government contract requirements, and policies.

Responsibilities

• Provide executive leadership and strategic direction for Utilization Management across inpatient, outpatient, and regulatory reporting.
• Ensure timely, compliant utilization management activities per CMS, state regulations, NCQA, URAC, and contracts.
• Maintain expert knowledge on all Utilization Management regulatory and policy requirements.

Skills

Regulatory compliance

Policy analysis

Healthcare management

Leadership

Education

Bachelor's Degree

Texas RN license

Job description

UnitedHealth Group seeks a Director of Utilization Management to lead executive oversight of inpatient and outpatient utilization review, prior authorization, and regulatory reporting across multiple sites in Texas. You will ensure policies meet CMS, state, and accreditation requirements while guiding clinical and administrative teams.

The role emphasizes strategic direction, policy development, and collaboration with health plans to optimize quality and cost outcomes.