Utilization Management RN Manager — Lead Clinical Oversight

Southwest General; Middleburg Heights (OH); On-site; USD 95,000 - 125,000; Full time

Job summary

Southwest General is seeking an Utilization Management RN Manager to lead the UM nursing team and translate strategy into daily execution. You will supervise, coach, and manage workflows while coordinating with physicians, case management, revenue cycle, payer relations, quality and compliance to ensure timely and evidence-informed decisions.

Ideal candidates have 5+ years of clinical/nursing or UM experience, 2+ years in leadership, and an Ohio nursing license.

Qualifications

• BSN required or equivalent per policy.
• Master’s degree preferred (Nursing, Healthcare Admin, Business, Public Health or related).
• Five+ years of progressive clinical nursing or UM experience; 3+ years in UM or related fields.
• Prior formal leadership experience; 2+ years of supervisory/management experience preferred.
• Current Ohio State Board of Nursing license required.
• Knowledge of UM and utilization review principles, including prospective, concurrent and retrospective review.
• Ability to interpret analytics, drive process improvement, and communicate across disciplines.

Responsibilities

• Lead day-to-day leadership and performance management of the UM nursing team.
• Provide supervision, coaching, and workflow management for assigned UM staff.
• Collaborate with physician advisors, case management, revenue cycle, payer relations, quality and compliance.
• Translate department strategy and payer requirements into daily execution.
• Support timely, accurate utilization management decisions and resource stewardship.

Skills

People leadership

Coaching

Performance management

Conflict resolution

Change management

Education

BSN or equivalent

Master’s degree in Nursing/Healthcare Admin/Business

Job description

Southwest General is seeking an Utilization Management RN Manager to lead the UM nursing team and translate strategy into daily execution. You will supervise, coach, and manage workflows while coordinating with physicians, case management, revenue cycle, payer relations, quality and compliance to ensure timely and evidence-informed decisions.

Ideal candidates have 5+ years of clinical/nursing or UM experience, 2+ years in leadership, and an Ohio nursing license.