Utilization Management Manager (Hybrid RN Leader)

Cambia Health Solutions; Renton (WA); Hybride; USD 105 000 - 172 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision coverage

Health savings account contribution

Paid time off & holidays

Retirement plan with 401(k) match

Paid parental time off

Wellness programs

Employee Assistance Fund

Commuting and parking benefits

Work from home options

Résumé du poste

Cambia Health Solutions is seeking a Senior leader to direct utilization management and payment review programs. You will oversee staff, set performance standards, and align policies with regulatory requirements across multiple plans.

Lead cross‑functional collaboration with supervisors and other departments to drive outcomes, manage budgets, and ensure quality and compliance in a dynamic health care environment.

Qualifications

• Bachelor's degree in nursing or related field; master's 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 the United States.

Responsabilités

• Lead development and execution of utilization and payment review policies.
• Manage staff performance, development, hiring, and retention.
• Communicate objectives and monitor metrics to meet standards.
• Manage department budget, expenditures, and resources.
• Develop and present educational updates to other departments.
• Ensure program quality and successful outcomes.

Connaissances

Leadership

Project management

Communication

Healthcare industry knowledge

Clinical case management

Data analysis

AI tools familiarity

Formation

Bachelor's degree in nursing or related field

Master's degree preferred

RN licensure (unrestricted)

Description du poste

Cambia Health Solutions is seeking a Senior leader to direct utilization management and payment review programs. You will oversee staff, set performance standards, and align policies with regulatory requirements across multiple plans.

Lead cross‑functional collaboration with supervisors and other departments to drive outcomes, manage budgets, and ensure quality and compliance in a dynamic health care environment.