Utilization Management Lead — Clinical Outcomes & Improvement

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

Benefits offered by this job

Paid Time Off

Healthcare benefits

FSA (Flexible Spending Accounts)

Family benefits

Retirement plan with employer match

Educational assistance

Job summary

Advocate Health seeks a clinical leader to manage our Utilization Management program in Charlotte, NC. The role requires an RN or NP license, a Master's degree, and 2+ years of nursing-related UM experience, with 5+ years preferred.

You will lead metric-driven initiatives, coordinate across disciplines, and ensure regulatory compliance. Excellent communication and mentoring skills are essential in this team-oriented environment.

Qualifications

• Master's degree required and RN/NP licensure in state of work.
• Two years of related nursing experience required; five years preferred.
• Appropriate Professional certification within 3 years of hire.

Responsibilities

• Develop and oversee Utilization Management program.
• Monitor and report UM metrics; design improvement projects.
• Lead and participate in cross-department initiatives.
• Maintain up-to-date policies and compliance for UM processes.
• Provide leadership, mentoring, and coaching to staff.
• Promote communication across Care Management and related teams.
• Oversee updates to Utilization Review tools and training.

Skills

Utilization Management

Process Improvement

Leadership

Mentoring

Collaboration

Regulatory Knowledge

Nursing Experience

Education

Master's degree

RN license or NP license

Tools

InterQual/Milliman guidelines

Job description

Advocate Health seeks a clinical leader to manage our Utilization Management program in Charlotte, NC. The role requires an RN or NP license, a Master's degree, and 2+ years of nursing-related UM experience, with 5+ years preferred.

You will lead metric-driven initiatives, coordinate across disciplines, and ensure regulatory compliance. Excellent communication and mentoring skills are essential in this team-oriented environment.