Utilization Management Lead (RN) — Operations & Strategy

1199seiubenefits; New York (NY); On-site; USD 80,000 - 120,000; Full time

Job summary

1199seiubenefits is seeking a qualified individual in New York to manage daily operations and supervise staff in a clinical environment. Candidates must hold a Bachelor’s Degree in Nursing or related fields along with a current NY State RN license. The role requires at least six years in Utilization/Case Management, including three years in leadership. The successful applicant will develop strategic plans, analyze operational processes, and maintain compliance with departmental protocols. Strong problem-solving and communication skills are essential.

Qualifications

• Minimum six years work experience in Utilization/Case Management/Appeals Programs.
• At least three years of progressive leadership and management experience.
• Experience with Milliman guidelines or other regulatory protocols.

Responsibilities

• Manage daily operations, workflow, and supervise staff.
• Develop strategic plans by collaborating with management.
• Analyze processes to improve workflow and operational efficiencies.

Skills

Clinical decision making

Staff supervision

Problem-solving

Time management

Analytical skills

Education

Bachelor’s Degree in Nursing, Business or Health Care Administration

Current New York State Registered Nurse (RN) license

Tools

Microsoft Office Suite

Automated Prior Authorization system

Job description

1199seiubenefits is seeking a qualified individual in New York to manage daily operations and supervise staff in a clinical environment. Candidates must hold a Bachelor’s Degree in Nursing or related fields along with a current NY State RN license. The role requires at least six years in Utilization/Case Management, including three years in leadership. The successful applicant will develop strategic plans, analyze operational processes, and maintain compliance with departmental protocols. Strong problem-solving and communication skills are essential.