RN Manager - Utilization Management

Elevance Health; Washington (District of Columbia); On-site; USD 115,092 - 172,638; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution

Equity stock purchase

Job summary

A healthcare management company is seeking an RN Manager - Utilization Management to oversee a team and manage a comprehensive medical management program. The role requires significant experience in healthcare management, compliance, and the development of medical programs. Candidates must hold a BA/BS in Nursing and possess an active, unrestricted RN license in D.C. The salary range for this position is between $115,092 and $172,638, along with additional benefits.

Qualifications

• Minimum of 6 years of experience aligned to the nursing license.
• 3 years of prior management experience.
• Active unrestricted RN license in the District of Columbia is required.

Responsibilities

• Provide oversight for Utilization Management execution.
• Develop and implement medical management programs.
• Ensure compliance with medical management standards.

Skills

Leadership

Medical Management

Utilization Management

Clinical Operations

Education

BA/BS in Nursing

Masters in Health/Nursing (preferred)

Job description

Location and Travel

Location: This role requires associates to work from the posted locations full‑time, enabling consistent face‑to‑face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in‑person interaction, communication, and immediate support.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

*This position requires travel to our Washington, D.C. office 4 days each week. The office is located at 609 H. Street NE.

Job Description

The RN Manager - Utilization Management is responsible for managing a team of physical health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in highly complex member populations with varying degrees of medical complexity and acuity.

Responsibilities

• Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may include but are not limited to:
• Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
• Ensures continued compliance with specific medical management standards.
• Engages in the development process for medical and clinical management policy, procedures, and strategies.
• Ensures program deliverables and compliance to regulatory and accreditation standards by monitoring established goals and implementing improvement strategies.
• Hires, trains, coaches, counsels, and evaluates performance of both UM
• Assists and provides back up coverage to Case Management team
• BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
• Current active unrestricted RN license in the District of Columbia is required.

Qualifications

• BA/BS in Nursing field and minimum of 6 years of experience as aligned to license which includes 3 years prior management experience
• Current active unrestricted RN license in the District of Columbia is required.

Preferred Qualifications

• Masters in related Health/Nursing field preferred.
• 3 years management experience with direct reports.
• Managed Care Utilization Management experience, preferably in the District.
• Working knowledge of clinical operations areas including regulatory and accreditation, compliance and quality management.
• Must have prior utilization management leadership experience

Salary

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $115,092 to $172,638.

Locations: District of Columbia (Washington, DC)

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, and any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Benefits

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [e-mail] for assistance.