Utilization Management Lead: Clinical Improvement

Hugh Chatham Health, Inc.; Charlotte (NC); On-site; USD 65,000 - 98,000; Full time

Benefits offered by this job

Paid Time Off

Health benefits

Educational assistance

Retirement plan

Job summary

Advocate Health in Charlotte, NC seeks a clinical leader for Utilization Management. The role drives UM development, aligns department goals with the system's mission, and coaches staff across care teams.

Required are a Master’s degree and active RN or NP licensure in the work state; two years of nursing-related experience with case management and utilization management. The position includes full-time hours and comprehensive benefits.

Qualifications

• Master's degree required and licensure as RN or NP in the state of work.
• Two years of related nursing experience; five years preferred; clinical care management/denial management experience preferred.

Responsibilities

• Manages the Utilization Management development and aligns department goals with system strategy.
• Monitors UM program effectiveness using metrics and reports results to stakeholders.
• Leads process improvement initiatives across departments and staff.
• Maintains knowledge of payers and regulatory bodies related to UM activities.
• Ensures UM policies and processes have up-to-date outcomes and compliance.

Skills

Leadership

Communication

Mentoring

Regulatory knowledge

Education

Master's degree

RN/NP licensure in state

Job description

Advocate Health in Charlotte, NC seeks a clinical leader for Utilization Management. The role drives UM development, aligns department goals with the system's mission, and coaches staff across care teams.

Required are a Master’s degree and active RN or NP licensure in the work state; two years of nursing-related experience with case management and utilization management. The position includes full-time hours and comprehensive benefits.