RN Utilization Management Lead

Acentra; United States; Remote; USD 84,000 - 104,000; Full time

Job summary

Acentra Health is seeking a Clinical Supervisor (RN) to oversee Utilization Management activities and ensure contract requirements are met with high standards. The role emphasizes clinical program quality and customer relationship enhancement across our national operations.

The position requires an active RN license ( Indiana or compact), 2+ years in healthcare management, and 5+ years in a lead utilization/quality role.

Qualifications

• Active, unrestricted RN license in Indiana or compact license.
• Associate degree or equivalent in nursing, healthcare administration or related area.
• 2+ years of healthcare management experience.
• 5+ years in a lead position in quality and utilization management.
• Bachelor's degree preferred.
• Excellent verbal and written communication skills.
• Current knowledge of utilization management.
• Customer-focused and capable of building relationships with internal and external customers.
• Organizational skills with ability to plan and prioritize multiple assignments.
• Current InterQual and Milliman criteria knowledge.
• Experience with systems that support Utilization Review processing.
• Ability to lead teams and provide technical guidance.

Responsibilities

• Manage and oversee Utilization Management activities.
• Ensure overall consistency, thoroughness, and accuracy of clinical programs.
• Oversee program to ensure clinical efficiencies, deliverables, and contract functions meet high standards.
• Strengthen relationships with customers and meet contract requirements.
• Provide day-to-day oversight to manage the utilization review program.
• Responsible for utilization reviews including prior authorization and retro reviews.
• Serve as a Subject Matter Expert (SME).
• Participate in collaborative decision-making among leadership and diverse teams.
• Perform other duties as assigned.
• Read, understand, and adhere to HIPAA and Privacy/Security Rules.

Skills

RN license

Verbal communication

Written communication

Utilization management knowledge

Customer focus

Organizational skills

Team leadership

Microsoft Office

HIPAA awareness

Education

Associate degree or equivalent

Bachelor's degree preferred

Tools

InterQual criteria knowledge

Milliman criteria knowledge

Utilization Review systems

Job description

Acentra Health is seeking a Clinical Supervisor (RN) to oversee Utilization Management activities and ensure contract requirements are met with high standards. The role emphasizes clinical program quality and customer relationship enhancement across our national operations.

The position requires an active RN license ( Indiana or compact), 2+ years in healthcare management, and 5+ years in a lead utilization/quality role.