RN Utilization Management Leader — Hybrid

Cambia Health; Medford (OR); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

Health benefits

401(k) with company match

Paid holidays

Job summary

Join Cambia Health as Manager of Utilization Management in a hybrid role across multiple western offices, including Portland and Salt Lake City. Lead a team of UM professionals, shape policies, and drive outcomes across prospective, concurrent, and post-service reviews.

You will oversee staff performance, develop supervisors, and collaborate with cross-functional leaders to meet regulatory standards while delivering high-quality member care and cost-effective utilization programs.

Qualifications

• Bachelor's degree in nursing or related field; master's preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent combination of education and experience.
• Current unrestricted Registered Nurse (RN) Licensure, in a state or territory of the United States

Responsibilities

• Leads the development and execution of effective utilization and/or payment review management policies, procedures and standards.
• Oversees the implementation of policy updates or process improvements as needed to ensure quality and service excellence.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Develops supervisors and participates in talent management activities.
• Regularly communicates organizational objectives and team goals.
• Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
• Collaborates with other leaders and across departments to resolve issues.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
• In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.
• Creates visibility and support for utilization management and/or payment review programs.
• Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.
• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.

Skills

Issue identification & problem solving

Resource & project management

Team leadership & development

Effective communication

Health insurance industry trends

Clinical case management

Utilization management

AI tools experience

Education

Bachelor's degree in nursing or related field

Master's degree preferred

Job description

Join Cambia Health as Manager of Utilization Management in a hybrid role across multiple western offices, including Portland and Salt Lake City. Lead a team of UM professionals, shape policies, and drive outcomes across prospective, concurrent, and post-service reviews.

You will oversee staff performance, develop supervisors, and collaborate with cross-functional leaders to meet regulatory standards while delivering high-quality member care and cost-effective utilization programs.