RN UR Manager: Lead Utilization & Care Coordination

Elliot Health System; New Hampshire; On-site; USD 95,000 - 135,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

Disability insurance

Life insurance

Pet insurance

Tuition reimbursement

403(b) retirement plan

Paid time off

Job summary

Elliot Health System in Manchester, NH seeks a Manager of Utilization Review to provide strategic, operational, and clinical leadership for the UR function under the Care Coordination umbrella.

You will ensure compliant level-of-care determinations, timely clinical documentation, and effective payer communication while partnering with physician leadership, revenue cycle, quality, and external payers to optimize patient outcomes and resource use.

Qualifications

• Graduate of an accredited nursing program with a nursing degree (BSN or higher). Master’s preferred.
• Experience in Utilization Review and InterQual criteria.
• Demonstrated leadership, staff development, and ability to drive performance.

Responsibilities

• Oversees UR staff and operations for accurate level-of-care determinations and clinical submissions.
• Provides second-level review and escalation for complex cases, denials, and appeals.
• Ensures consistent application of InterQual criteria and strong clinical documentation practices.
• Monitors denial mitigation strategies, tracks trends, and implements corrective actions.
• Collaborates with finance, revenue cycle, and payer partners to optimize financial health and appropriate resource use.
• Ensures CMS, payer contracts, accreditation standards, and hospital policies are met.
• Participates in Utilization Management Oversight committees, audits, and regulatory reviews.

Skills

Leadership

Utilization management

InterQual criteria

Clinical decision making

Analytical skills

Process improvement

Communication

Education

Bachelor's degree in Nursing

Master's degree (preferred)

Job description

Elliot Health System in Manchester, NH seeks a Manager of Utilization Review to provide strategic, operational, and clinical leadership for the UR function under the Care Coordination umbrella.

You will ensure compliant level-of-care determinations, timely clinical documentation, and effective payer communication while partnering with physician leadership, revenue cycle, quality, and external payers to optimize patient outcomes and resource use.