Utilization Management Leader (Hybrid, RN)

Cambia Health; Boise (ID); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Hybrid work option

Competitive salary with bonus target (

Comprehensive benefits package

Job summary

Cambia Health in Boise/Salt Lake City area seeks a Manager of Utilization Management to lead review policies, oversee staff, and ensure program quality across plans. You will set performance standards and drive improvements while coordinating with leaders and partners.

Applicants should have RN licensure, 5+ years clinical care, 5+ years leadership, and strong evidence of process improvement, budgeting, and cross-functional collaboration in a health-insurance setting.

Qualifications

• Bachelor's degree in nursing or related field; masters preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.
• Current unrestricted RN licensure in a US state.

Responsibilities

• Leads the development and execution of utilization and/or payment review policies and standards.
• Oversees policy updates and process improvements to ensure quality and service.
• Manages staff performance reviews, development, hiring, coaching and retention.
• Develops supervisors and participates in talent management.
• Monitors results and metrics to ensure compliance with standards.
• Collaborates across departments to resolve issues and manage budgets.

Skills

Issue identification and solutions

Cross-functional collaboration

Resource management

Team leadership

Hiring and coaching

Effective communication

Health insurance industry knowledge

Clinical case management

Statistical analysis

AI tools usage

Education

Bachelor's degree in nursing or related field

RN licensure (Current, unrestricted)

Masters preferred

Tools

AI tools

Job description

Cambia Health in Boise/Salt Lake City area seeks a Manager of Utilization Management to lead review policies, oversee staff, and ensure program quality across plans. You will set performance standards and drive improvements while coordinating with leaders and partners.

Applicants should have RN licensure, 5+ years clinical care, 5+ years leadership, and strong evidence of process improvement, budgeting, and cross-functional collaboration in a health-insurance setting.