RN Leader - Utilization Management (Hybrid)

Cambia Health; Portland (OR); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

Market-leading 401(k) match

Medical, dental and vision coverage

Job summary

Cambia Health is seeking a Manager of Utilization Management to lead and direct a diverse team across multiple locations in a hybrid role. The role emphasizes policy development, performance management, and cross-functional collaboration to optimize care utilization and payments.

The position requires RN licensure, significant clinical and leadership experience, and familiarity with insurance industry practices. Strong communication and AI-enabled decision support are valued.

Qualifications

• Bachelor's degree in nursing or related field; masters preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent combination of education and experience.
• Current unrestricted Registered Nurse (RN) Licensure in the United States.

Responsibilities

• Leads development and execution of utilization and/or payment review policies, procedures and standards.
• Oversees policy updates or process improvements to ensure quality and service excellence.
• Manages staff at management level including performance reviews, development, hiring, coaching and retention.
• Develops supervisors and participates in talent management activities.
• Regularly communicates organizational objectives and team goals.
• Monitors results and metrics to ensure deliverables and compliance with standards.
• Collaborates with leaders across departments to resolve issues.
• Manages department budget and resources, oversees project plans.

Skills

Leadership experience

People management

Budgeting

Communication

Process improvement

Project management

AI tools awareness

Education

Bachelor's degree in nursing

Master's degree preferred

RN licensure

Tools

AI tools,

Job description

Cambia Health is seeking a Manager of Utilization Management to lead and direct a diverse team across multiple locations in a hybrid role. The role emphasizes policy development, performance management, and cross-functional collaboration to optimize care utilization and payments.

The position requires RN licensure, significant clinical and leadership experience, and familiarity with insurance industry practices. Strong communication and AI-enabled decision support are valued.