Strategic RN Leader, Utilization Management

Optum; United States; Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401(k) contribution

Job summary

OptumCare is seeking a Director of Utilization Management to lead executive oversight of inpatient and outpatient utilization review, prior authorization, concurrent and retrospective reviews, and regulatory submissions. The role requires a Texas RN license and 10+ years in managed care with 5 years in leadership.

The Director will own regulatory interpretation, policy development, and alignment with CMS, NCQA, URAC, and delegated health plans, ensuring timely, accurate, and compliant operations

Qualifications

• Active Texas Registered Nurse (RN) license or valid multistate compact RN license.
• 10+ years of experience in managed care health insurance field, with 5 years in management capacity.
• Experience analyzing complex regulations, government contract requirements, and policies and procedures.

Responsibilities

• Provide executive leadership and oversight for all Utilization Management functions.
• Ensure compliance with CMS, Texas DIO, NCQA, URAC, and other requirements.
• Maintain policies and governance for Utilization Management and PolicyTech.

Skills

RN license

Managed care

Leadership

Regulatory analysis

Education

Bachelor's degree

Master's degree

Job description

OptumCare is seeking a Director of Utilization Management to lead executive oversight of inpatient and outpatient utilization review, prior authorization, concurrent and retrospective reviews, and regulatory submissions. The role requires a Texas RN license and 10+ years in managed care with 5 years in leadership.

The Director will own regulatory interpretation, policy development, and alignment with CMS, NCQA, URAC, and delegated health plans, ensuring timely, accurate, and compliant operations