RN Leader — Utilization Management (Hybrid)

Cambia Health; Spokane (WA); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

Generous benefits

Job summary

Cambia Health is seeking a Manager of Utilization Management in a hybrid role (3 days in office). You will lead the UM team, shape policies, and ensure high-quality review programs across plans. The role includes staff management, budgeting, and cross-department collaboration.

Qualified candidates have RN licensure, 5+ years in clinical care and leadership, plus experience in the insurance sector. Regional pay scales apply with a national range; relocation flexibility is noted.

Qualifications

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

Responsibilities

• Leads development and execution of utilization/payment review policies and standards.
• Oversees policy updates and process improvements for quality and service.
• Manages staff performance, development, hiring, coaching and retention.
• Drives talent management and succession planning.
• Communicates organizational objectives and team goals regularly.
• Monitors results and budgets; ensures compliance and resource alignment.
• Collaborates with leaders across departments to resolve issues.

Skills

Leadership

Clinical expertise

Communication

Problem solving

Education

Bachelor's degree in nursing or related field

Master's degree preferred

Job description

Cambia Health is seeking a Manager of Utilization Management in a hybrid role (3 days in office). You will lead the UM team, shape policies, and ensure high-quality review programs across plans. The role includes staff management, budgeting, and cross-department collaboration.

Qualified candidates have RN licensure, 5+ years in clinical care and leadership, plus experience in the insurance sector. Regional pay scales apply with a national range; relocation flexibility is noted.