RN Utilization Management Lead — Clinical Ops & Compliance

Prolink; Saginaw (MI); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Retirement plan with employer match

Paid time off

Wellness programs

Tuition reimbursement

Job summary

Prolink’s confidential acute care hospital in Saginaw, MI is seeking a Clinical Manager, Utilization Management to lead the UM department. This leadership role oversees utilization review operations, staff supervision, and collaboration with Physician Advisors to ensure appropriate, compliant patient care for a 280-300 daily census.

The Clinical Manager reports to the Director of Revenue Cycle and handles daily UM operations, budget, and cross-functional collaboration with Coding, CDI, Case

Qualifications

• Bachelor's degree required and MI RN license.

Responsibilities

• Lead Utilization Management daily operations and staff supervision.
• Ensure CMS Conditions of Participation compliance and clinical review guidelines.
• Oversee department budget, payroll, staff evaluations, and corrective actions.
• Collaborate with Physician Advisors on medical necessity and level-of-care decisions.
• Coordinate with Revenue Cycle, Coding/CDI, Case Management, and Billing/Denials leadership.
• Chair the Utilization Committee and drive department strategy and performance metrics.
• Oversee onboarding and transition with outgoing team and Physician Advisor.

Skills

UM leadership

RN leadership

CMS/POC compliance

Interdepartmental collaboration

Education

Bachelor's Degree

RN License in MI

Tools

Epic

InterQual

MCG

Job description

Prolink’s confidential acute care hospital in Saginaw, MI is seeking a Clinical Manager, Utilization Management to lead the UM department. This leadership role oversees utilization review operations, staff supervision, and collaboration with Physician Advisors to ensure appropriate, compliant patient care for a 280-300 daily census.

The Clinical Manager reports to the Director of Revenue Cycle and handles daily UM operations, budget, and cross-functional collaboration with Coding, CDI, Case