UM Operations Leader - Hybrid (RN)

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 83,000 - 171,000; Full time

Job summary

CareFirst BlueCross BlueShield in the Baltimore area is seeking a Supervisor, Utilization Management to lead the UM team, ensuring appropriate care coordination and adherence to UR policies. The role supports hybrid work, with a mix of home and CareFirst site days to meet business needs.

The successful candidate will have RN licensure, a nursing degree or equivalent experience, and at least 3 years in medical/surgical settings with leadership.

Qualifications

• Bachelor's Degree in Nursing OR equivalent: additional 4 years of relevant work experience if no degree.
• Minimum 3 years Medical/surgical experience including inpatient/outpatient/home and hospice care with leadership.
• RN license in state or compact licensure at hire.

Responsibilities

• Supervise daily UM staff operations and develop a high-performing team.
• Ensure compliance with UR policies, state guidelines, and accreditation standards.
• Coordinate data collection and validation to support reporting and decision-making.
• Identify process improvements to boost efficiency and outcomes.
• Communicate department status, trends, and action plans to management.

Skills

Analytical skills

Multitasking & organization

Knowledge of accreditation standards &

Communication skills

Microsoft Office

Mentoring/coaching

Education

Bachelor's Degree in Nursing or related field

Tools

Microsoft Office Suite

Job description

CareFirst BlueCross BlueShield in the Baltimore area is seeking a Supervisor, Utilization Management to lead the UM team, ensuring appropriate care coordination and adherence to UR policies. The role supports hybrid work, with a mix of home and CareFirst site days to meet business needs.

The successful candidate will have RN licensure, a nursing degree or equivalent experience, and at least 3 years in medical/surgical settings with leadership.