Utilization Management Leader (RN) – Hybrid

Cambia Health; Renton (WA); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

Job summary

Cambia Health in Renton, WA seeks a Manager of Utilization Management to lead the UM team across multiple plans in a hybrid role (3 days in the office). The role focuses on policy development, staff leadership, and coordinating with clinical and operations partners to ensure quality and compliant utilization processes.

The position requires RN licensure with significant leadership and insurance industry experience, offering remote-friendly options and relocation consideration for qualified

Qualifications

• Bachelor's degree in nursing or related field (masters preferred).
• Minimum 5 years of clinical care experience.
• Minimum 5 years of leadership experience.
• At least 7 years in the insurance industry or equivalent.

Responsibilities

• Leads the development and execution of utilization management policies and standards.
• Oversees staff performance reviews, coaching, and development.
• Manages budgets, expenditures, and resource allocation for the department.
• Collaborates across departments to resolve issues and ensure quality and regulatory compliance.
• Maintains clinical competency and current knowledge of medical practices.

Education

Bachelor's degree in nursing or related field

5 years of clinical care experience

5 years of leadership experience

7 years of insurance industry experience

Current unrestricted RN licensure

Job description

Cambia Health in Renton, WA seeks a Manager of Utilization Management to lead the UM team across multiple plans in a hybrid role (3 days in the office). The role focuses on policy development, staff leadership, and coordinating with clinical and operations partners to ensure quality and compliant utilization processes.

The position requires RN licensure with significant leadership and insurance industry experience, offering remote-friendly options and relocation consideration for qualified