Utilization Management Lead — Care Quality & Improvement

Advocate Health Care; Charlotte (NC); On-site; USD 65,000 - 98,000; Full time

Job summary

Advocate Health Care, based in Charlotte, NC, is seeking a strong Utilization Management leader for a full-time role in Case Management. You will guide the UM program, monitor outcomes, and coordinate with multiple departments to drive policy, process improvement, and compliance.

This position emphasizes leadership, teaching, and collaboration with physicians, billing, and analytics teams. Required are a Master's in nursing with RN/NP licensure and several years of relevant experience, including

Qualifications

• Master's degree required; RN license or NP license in state of work; 2 years nursing-related experience required; 5 years preferred.
• Experience in case management/discharge planning/utilization management/denial management/medical necessity review in acute care, home care, long-term care, physician office, or insurance plan.

Responsibilities

• Lead Utilization Management development and monitor department goals.
• Provide leadership, mentoring, and coaching to UR staff.
• Ensure compliance with regulatory standards and maintain up-to-date policies.

Skills

Utilization management

Process improvement

Leadership

Interdisciplinary collaboration

Education

Master's degree

Tools

InterQual/Milliman

Job description

Advocate Health Care, based in Charlotte, NC, is seeking a strong Utilization Management leader for a full-time role in Case Management. You will guide the UM program, monitor outcomes, and coordinate with multiple departments to drive policy, process improvement, and compliance.

This position emphasizes leadership, teaching, and collaboration with physicians, billing, and analytics teams. Required are a Master's in nursing with RN/NP licensure and several years of relevant experience, including