UR RN Manager: Lead Utilization & Denials Excellence

Onvida Health; Yuma (AZ); On-site; USD 100,000 - 161,000; Full time

Job summary

Onvida Health in Yuma, AZ, seeks a UR RN Manager to lead the Utilization Review program, ensuring medical necessity reviews, status determinations, and timely reimbursement while guiding staff development and cross‑functional collaboration.

The role requires leadership of UR and Denials Nurses, adherence to CMS/Medicare/Medicaid guidelines, and partnership with Revenue Cycle and clinical leadership to drive performance and quality care.

Qualifications

• 3+ years related experience in hospital Utilization Management.
• AZ RN License.
• BLS (AHA) certification.

Responsibilities

• Oversee the Utilization Management Department's operations and staff.
• Lead utilization review and denials teams to optimize patient status reviews and reimbursement.
• Ensure compliance with CMS Conditions of Participation, Medicare/Medicaid regulations, and accreditation standards.
• Collaborate with Revenue Cycle, CDI, Quality, and physician leadership to support regulatory compliance and performance improvement.

Skills

Leadership

Utilization review

Regulatory compliance

Education

Bachelor's Degree in Nursing

Job description

Onvida Health in Yuma, AZ, seeks a UR RN Manager to lead the Utilization Review program, ensuring medical necessity reviews, status determinations, and timely reimbursement while guiding staff development and cross‑functional collaboration.

The role requires leadership of UR and Denials Nurses, adherence to CMS/Medicare/Medicaid guidelines, and partnership with Revenue Cycle and clinical leadership to drive performance and quality care.