Senior RN Leader - Utilization Management & Compliance

UnitedHealth Group; Pearland (TX); Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group in Texas is seeking a Director of Utilization Management to provide executive leadership, strategic direction, and comprehensive operational oversight across inpatient and outpatient review processes, regulatory reporting, and delegated plan requirements. The role requires 10+ years in managed care, 5+ years in management, a Texas RN license, and a Bachelor's degree.

You will ensure CMS, TDI, NCQA, and URAC compliance, develop policies, and drive performance improvements in a

Qualifications

• Bachelor's degree required.
• Active Texas RN license or multi-state compact.
• 10+ years in managed care health insurance with 5+ years in management.
• Experience analyzing complex regulations, government contract requirements, and policies.

Responsibilities

• Provide executive leadership, strategic direction, and comprehensive operational oversight for all Utilization Management functions.
• Ensure regulatory compliance with CMS, Texas DOI, NCQA, URAC, and delegated health plans.
• Serve as subject matter expert on regulatory, policy, and auditing requirements for Utilization Management.
• Develop and maintain policies, reporting methods, and data governance across the department.

Skills

Leadership experience

Regulatory analysis

Policy interpretation

Stakeholder collaboration

Education

Bachelor's Degree

Active Texas RN license

Job description

UnitedHealth Group in Texas is seeking a Director of Utilization Management to provide executive leadership, strategic direction, and comprehensive operational oversight across inpatient and outpatient review processes, regulatory reporting, and delegated plan requirements. The role requires 10+ years in managed care, 5+ years in management, a Texas RN license, and a Bachelor's degree.

You will ensure CMS, TDI, NCQA, and URAC compliance, develop policies, and drive performance improvements in a