RN Leader - Utilization Management (Hybrid)

Cambia Health Solutions; Boise (ID); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Health savings account

Paid time off

401(k) match

Parental leave

Wellness programs

Employee assistance

Job summary

Cambia Health Solutions in Boise, ID, seeks a Manager of Utilization Management to lead a team across departments, shaping policies and ensuring service excellence. You will oversee staff performance, budgeting, and cross‑functional initiatives to improve patient care and program outcomes.

This leadership role emphasizes clinical competency, collaboration with government and providers, and strategic planning to drive meaningful improvements in health care delivery across Cambia plans.

Qualifications

• Bachelor's degree in nursing or related field; master's preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.

Responsibilities

• Lead development and execution of utilization/policy review standards.
• Oversee staff performance reviews and development; hire and coach.
• Monitor results and ensure compliance with regulatory standards.
• Manage department budget and resource allocation; approve expenditures.
• Provide education and communications about programs to staff and providers.

Skills

Clinical leadership

Staff management

Communication skills

Regulatory knowledge

Education

Bachelor's degree in nursing or related field

Master's degree preferred

Job description

Cambia Health Solutions in Boise, ID, seeks a Manager of Utilization Management to lead a team across departments, shaping policies and ensuring service excellence. You will oversee staff performance, budgeting, and cross‑functional initiatives to improve patient care and program outcomes.

This leadership role emphasizes clinical competency, collaboration with government and providers, and strategic planning to drive meaningful improvements in health care delivery across Cambia plans.