Utilization Management Leader - RN, Quality & Compliance

P3 Health Partners; Henderson (NV); Hybrid; USD 100,000 - 140,000; Full time

Benefits offered by this job

Hybrid work arrangement

Occasional travel to delegated markets

Job summary

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of the UM department, driving quality, efficiency, and regulatory compliance while leading a team of UM professionals.

This leadership role collaborates with clinical and operational stakeholders, mentors staff, supports organizational growth, and contributes to initiatives that improve patient care and healthcare value.

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.
• Minimum of five (5) years of clinical nursing experience.
• Minimum of two (2) years of experience within managed care, an HMO, or a global risk-bearing provider organization.
• Minimum of two (2) years of supervisory or management experience.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, Outlook).

Responsibilities

• Lead and oversee the daily operations of the Utilization Management department, including staff supervision and performance management.
• Monitor departmental workflows for efficiency, accuracy, and regulatory compliance.
• Serve as a subject matter expert and provide ongoing education and mentorship to UM staff.
• Promote a culture of quality, accountability, and continuous improvement within the department.
• Participate in UM and Quality Assurance committees and support organizational quality initiatives.
• Assist with audits conducted by health plans, NCQA, CMS, and other regulators.

Skills

RN licensure

Nursing experience

Managed care

Supervisory experience

Microsoft Office

Licensure in multiple markets

Education

BSN preferred

Bachelor of Nursing

Tools

Microsoft Office

Job description

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of the UM department, driving quality, efficiency, and regulatory compliance while leading a team of UM professionals.

This leadership role collaborates with clinical and operational stakeholders, mentors staff, supports organizational growth, and contributes to initiatives that improve patient care and healthcare value.