Utilization Review Manager — Lead Clinical Optimization

Capital Health Screening Centre; Rockford (IL); On-site; USD 98,000 - 128,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage

In-House Employee Pharmacy

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Retirement Savings and Investment Plan

Life Insurance & AD&D

Disability Benefits – LTD/STD

Employee Assistance Program

Commuter Transit

Commuter Parking

Supplemental Life Insurance

Job summary

Capital Health is seeking a Utilization Review leader with a BSN to supervise UR staff and drive quality patient care. This on-site role manages clinical reviews, payer communications, and performance-improvement initiatives while ensuring compliance with policies.

The position requires several years of nursing experience in case management, with RN licensure in NJ, and offers a comprehensive benefits package. 40-hour weeks, non-remote.

Qualifications

• BSN required; ADN with experience may be considered.
• Four years of nursing experience in case management, utilization review, discharge planning or related areas with BSN; six years with ADN.
• Registered Nurse license in NJ.

Responsibilities

• Oversee daily Utilization Review functions and staff performance.
• Supervise UR staff and manage staffing levels across shifts.
• Coordinate with payers and ensure proper documentation of reviews.
• Lead performance improvement initiatives and regulatory compliance.
• Participate in system-wide committees and interdepartmental projects.
• Hire, train and mentor utilization management staff.

Skills

Nursing

Leadership

Case Management

Staff Supervision

Communication

Education

BSN in Nursing

ADN accepted with experience

Job description

Capital Health is seeking a Utilization Review leader with a BSN to supervise UR staff and drive quality patient care. This on-site role manages clinical reviews, payer communications, and performance-improvement initiatives while ensuring compliance with policies.

The position requires several years of nursing experience in case management, with RN licensure in NJ, and offers a comprehensive benefits package. 40-hour weeks, non-remote.