RN Utilization Management Lead (Hybrid)

Cambia Health Solutions; Portland (OR); Híbrido; USD 105.000 - 172.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Retirement plan

Paid time off

Work from home options

Descripción de la vacante

Cambia Health Solutions is seeking an experienced Manager of Utilization Management to lead a team of professionals and drive high-quality review programs across plans.

You will oversee staff, set performance standards, manage budgets, and collaborate with leaders across departments to improve outcomes for members and ensure regulatory compliance. This role requires RN licensure and strong clinical leadership.

Formación

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

Responsabilidades

• Leads the development and execution of utilization and/or payment review policies and standards.
• Manages staff performance reviews, development, hiring, coaching and retention.
• Monitors results and metrics to ensure deliverables and compliance with standards.
• Manages department budget, expenditures, and resource allocation.
• Establishes long-term goals with division leadership and adapts plans as needed.
• Develops educational materials and communicates program information to staff, providers, and stakeholders.
• Maintains clinical competency and stays current on medical practices and industry trends.
• Provides direction to the team to achieve common goals.

Conocimientos

Leadership

Communication

Project management

Budgeting

AI tools

Educación

Bachelor's degree in nursing

Master's degree preferred

Herramientas

AI tools

Descripción del empleo

Cambia Health Solutions is seeking an experienced Manager of Utilization Management to lead a team of professionals and drive high-quality review programs across plans.

You will oversee staff, set performance standards, manage budgets, and collaborate with leaders across departments to improve outcomes for members and ensure regulatory compliance. This role requires RN licensure and strong clinical leadership.