RN Utilization Review Lead - Lead Care Optimization

CHRISTUS Health; Alamogordo (NM); On-site; USD 85,000 - 110,000; Full time

Job summary

CHRISTUS Health in Alamogordo, NM is seeking an RN Utilization Review Lead to guide the Utilization Management team, ensuring appropriate care and cost containment. You will serve as a clinical resource, communicate with providers, and drive quality metrics while leading daily UM operations.

The role requires a Bachelor of Nursing, 3+ years in a lead nursing role, and an active RN license; CPR and Case Management certification are preferred.

Qualifications

• Bachelor of Nursing required.
• 3+ years in a lead nursing role.
• RN license in state of employment or compact.
• CPR certification preferred.
• Certification in Case Management preferred.

Responsibilities

• Oversee UM functions including Pre-Certification, Concurrent Review, and Discharge Planning.
• Lead and supervise the UM Nursing Team to contain costs and stay aligned with quality metrics.
• Coordinate with internal and external clinicians; relay data to obtain approvals.
• Develop and monitor goals; provide coaching and performance reviews.
• Promote open communication and teamwork within the care team.
• Assume other duties as assigned.

Skills

Leadership

Healthcare compliance

Clinical decision making

Education

Bachelor of Nursing

Job description

CHRISTUS Health in Alamogordo, NM is seeking an RN Utilization Review Lead to guide the Utilization Management team, ensuring appropriate care and cost containment. You will serve as a clinical resource, communicate with providers, and drive quality metrics while leading daily UM operations.

The role requires a Bachelor of Nursing, 3+ years in a lead nursing role, and an active RN license; CPR and Case Management certification are preferred.