RN Leader, Utilization Management (Hybrid)

Cambia Health Solutions, Inc.; Salt Lake City (UT); Hybride; USD 105 000 - 172 000; Plein temps

Avantages offerts par ce poste

Work from home options

Health benefits

401(k) with company match

Generous PTO

Résumé du poste

Cambia Health Solutions, Inc. seeks a Manager in Utilization Management to lead clinical and support staff across multiple sites. The role drives utilization and payment review programs, staff development, and cross-functional collaboration to improve care quality and efficiency.

Requires RN licensure and 5+ years clinical leadership with broad insurance knowledge. Hybrid work option with relocation flexibility, salary ranges disclosed in the posting.

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.

Responsabilités

• Lead development and execution of utilization management policies and standards.
• Oversee staff performance reviews, coaching, hiring and retention.
• Monitor metrics to ensure deliverables and regulatory compliance.
• Manage department budget and resource allocation; supervise multiple locations.

Connaissances

Issue identification and resolution

Resource management

Team leadership

Effective communication

Health insurance trends

Clinical UM practices

Statistical analysis in UM

AI tools usage

Formation

Bachelor's degree in nursing or related field

Masters preferred

Description du poste

Cambia Health Solutions, Inc. seeks a Manager in Utilization Management to lead clinical and support staff across multiple sites. The role drives utilization and payment review programs, staff development, and cross-functional collaboration to improve care quality and efficiency.

Requires RN licensure and 5+ years clinical leadership with broad insurance knowledge. Hybrid work option with relocation flexibility, salary ranges disclosed in the posting.