RN Director, Utilization Management — Hybrid Leadership

Optum; Pearland (TX); Hybrid; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

OptumCare's Kelsey-Seybold Clinics in Houston area seeks a Director of Utilization Management (RN) to provide executive oversight across inpatient and outpatient utilization, regulatory compliance, and policy development. The role requires a Texas RN license and 10+ years in managed care with 5+ in leadership, plus strong regulatory analysis experience.

The position is hybrid, with responsibilities spanning governance, reporting, and strategic direction to improve quality, efficiency, and cost

Qualifications

• Bachelor's degree required, RN licensure in Texas or multi-state compact.
• 10+ years in managed care health insurance with 5+ years in management.
• Experience analyzing complex regulations, government contract requirements, policies and procedures.

Responsibilities

• Provide executive leadership and oversight for all Utilization Management functions, including reviews and prior authorizations.
• Ensure compliance with CMS, Texas D IR, NCQA, URAC, plan requirements and regulatory submissions.
• Serve as SME for clinical, regulatory, policy and reporting activities within Utilization Management.
• Develop and maintain policies, governance, and data reporting processes.

Skills

Managed care experience

Regulatory analysis

Leadership/management

Policy interpretation

Education

Bachelor's Degree

RN license (Texas or multi-state compact)

Job description

OptumCare's Kelsey-Seybold Clinics in Houston area seeks a Director of Utilization Management (RN) to provide executive oversight across inpatient and outpatient utilization, regulatory compliance, and policy development. The role requires a Texas RN license and 10+ years in managed care with 5+ in leadership, plus strong regulatory analysis experience.

The position is hybrid, with responsibilities spanning governance, reporting, and strategic direction to improve quality, efficiency, and cost