Utilization Management RN: Drive Timely, Quality Care

Liberty Health; Wilmington (NC); On-site; USD 90,000 - 110,000; Full time

Job summary

Liberty Health is seeking an experienced Utilization Management RN in North Carolina to oversee UM queues, authorizations, and discharge planning. You will support clinical teams, ensure policy compliance, and prepare UM reports for leadership.

The role requires an RN license with 3–5 years in clinical settings and 1–5 years in UM or managed care, with familiarity with InterQual/MCG criteria and Medicare Advantage. A valid driver’s license and strong communication skills are essential.

Qualifications

• Licensed RN with 3–5 years of clinical experience
• Active RN license required; compact license preferred
• 1–5 years managed care utilization management experience
• Experience with health plan utilization management, initial reviews and discharge planning
• Medicare Advantage experience required
• Familiarity with InterQual or MCG criteria preferred
• Strong computer skills, attention to detail, interpersonal skills
• Must have a valid driver’s license

Responsibilities

• Manage UM queues and dashboards; ensure timely authorizations
• Assist with discharge planning and adherence to policies
• Prepare Utilization Management reports for Executive Leadership
• Review admissions and service requests against clinical guidelines
• Coordinate with care teams and documentation; support coding and denials/appeals
• Participate in on-call rotation and after-hours work as needed
• Contribute to UM meetings and written policies/workflows
• Travel to corporate office less than 10% for department meetings

Skills

Utilization Management

Case Management

Discharge Planning

Clinical Experience

InterQual/MCG Criteria

Education

Registered Nurse license

Job description

Liberty Health is seeking an experienced Utilization Management RN in North Carolina to oversee UM queues, authorizations, and discharge planning. You will support clinical teams, ensure policy compliance, and prepare UM reports for leadership.

The role requires an RN license with 3–5 years in clinical settings and 1–5 years in UM or managed care, with familiarity with InterQual/MCG criteria and Medicare Advantage. A valid driver’s license and strong communication skills are essential.