Utilization Management Leader — RN, Quality & Care Ops (Hybrid)

P3 Health Partners, Inc.; Tucson, Northern (AZ, KY); Hybrid; USD 100,000 - 140,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of the UM department, guiding a team and ensuring members receive appropriate and timely care across the organization.

The role emphasizes quality, compliance, audits, staff development, and collaboration with clinical and operational stakeholders. A hybrid schedule is offered with in-office work three days per week.

Qualifications

• Graduate of an accredited school of nursing.
• Active, unrestricted RN license in AZ, CA, NE, NV, or OR.
• Ability to obtain licensure in all delegated markets within one year of hire.
• Minimum of five years of clinical nursing experience.
• Minimum of two years in managed care or a global risk-bearing provider organization.
• Minimum of two years supervisory or management experience.
• Proficiency with Microsoft Office applications.

Responsibilities

• Lead and manage daily operations of the Utilization Management department, including staff supervision and performance management.
• Monitor workflows for efficiency, accuracy, and compliance with regulations and organizational requirements.
• Provide ongoing education, mentorship, and support to UM staff.
• Promote a culture of quality, accountability, and continuous improvement.
• Participate in UM and Quality Assurance committees and support quality initiatives.
• Assist with audits by health plans, NCQA, CMS, and others.
• Collaborate with cross-functional teams (Case Management, Clinical Operations, Quality Improvement, Claims, Network Development, Configuration, Finance).
• Develop and maintain departmental policies, procedures, and workflow standards.
• Identify process improvements and system enhancements.
• Maintain expertise in Medicare Advantage regulations and provider/facility contracts.
• Partner with Medical Directors for medical necessity determinations.
• Support strategic planning, budgeting, and growth initiatives.
• Assist with implementation for new markets and programs.

Skills

Leadership

Regulatory knowledge

Communication

Strategic planning

Mentoring / staff development

Project management

Cross-functional collaboration

Quality improvement

Clinical compliance

Education

Graduate of an accredited nursing program

Bachelor's degree in Nursing (BSN)

Tools

Microsoft Office

Job description

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of the UM department, guiding a team and ensuring members receive appropriate and timely care across the organization.

The role emphasizes quality, compliance, audits, staff development, and collaboration with clinical and operational stakeholders. A hybrid schedule is offered with in-office work three days per week.