Utilization Management Manager - Hybrid Care Leader

Sky Mavis; Henderson (NV); Hybrid; USD 100,000 - 140,000; Full time

Job summary

P3 Health Partners is seeking an experienced Utilization Management Manager to lead the UM department, drive quality, efficiency, and compliance, and mentor staff in a hybrid work setting.

The role requires an RN with five years of clinical nursing experience and at least two years in managed care, with the ability to obtain licensure in all delegated markets within one year. Strong MS Office skills are expected.

Qualifications

• Graduate of an accredited school of nursing.
• Active, unrestricted RN license in one of the delegated markets.
• 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 of experience within managed care, an HMO, or a global risk-bearing provider organization.
• Minimum of two years of supervisory or management experience.
• Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Responsibilities

• Lead and oversee the daily operations of the Utilization Management department, including staff supervision, coaching, and performance management.
• Monitor departmental workflows to ensure efficiency, accuracy, and regulatory compliance.
• Serve as SME and mentor UM staff with ongoing education and support.
• Promote a culture of quality, accountability, and continuous improvement.
• Participate in UM and Quality Assurance committees and support quality initiatives.
• Assist with audits conducted by health plans, NCQA, CMS and other regulators.
• Collaborate with cross-functional teams (Case Management, Clinical Ops, Quality) and Finance.
• Develop, implement, and maintain department policies and workflows.
• Identify process improvements and recommend system enhancements and efficiencies.
• Maintain expertise in Medicare Advantage regulations and payer contracts.
• Partner with Medical Directors to support medical necessity determinations.

Skills

Leadership

Utilization management

Regulatory knowledge

Communication

Project management

Education

RN licensure

BSN preferred

Tools

Microsoft Office

Job description

P3 Health Partners is seeking an experienced Utilization Management Manager to lead the UM department, drive quality, efficiency, and compliance, and mentor staff in a hybrid work setting.

The role requires an RN with five years of clinical nursing experience and at least two years in managed care, with the ability to obtain licensure in all delegated markets within one year. Strong MS Office skills are expected.