Utilization Review Nursing Manager

Central Health; Austin (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Sendero Health Plans seeks a Manager of Utilization Review Nursing to lead and develop the Utilization Review Nursing team. You will ensure compliant and timely utilization review across multiple lines of business, including HMO, Commercial, Medicare, Medicaid, and Self-Funded plans.

Your role requires strong knowledge of regulatory standards, quality measures, and InterQual guidelines, with a focus on operational excellence and cross-functional collaboration with Medical and Compliance teams.

Qualifications

• Associates Degree (or higher) in Nursing, Healthcare Management, Healthcare Administration, or related field is required.
• Minimum 5 years in utilization management within a health plan or health insurance environment, including Texas-regulated operations.
• Minimum 1 year of leadership experience in health plan, utilization management, or related setting.
• Current LPN or RN license in Texas or a compact state, active and in good standing at hire.

Responsibilities

• Oversee day-to-day Utilization Review Nursing operations to ensure timely, accurate, and compliant activities.
• Provide leadership, coaching, and professional development to the Utilization Review Nursing team.
• Support recruitment, onboarding, and workload management for the team.
• Monitor utilization review volumes, turnaround times, and quality measures; drive process improvements.
• Maintain program descriptions, policies, and procedures in line with Texas DIO, CMS, NCQA, and other standards.

Skills

Utilization management

Leadership

Regulatory compliance

InterQual guidelines

Healthcare operations

Education

Associates Degree in Nursing

Tools

Microsoft Office

EHR systems

Job description

Sendero Health Plans seeks a Manager of Utilization Review Nursing to lead and develop the Utilization Review Nursing team. You will ensure compliant and timely utilization review across multiple lines of business, including HMO, Commercial, Medicare, Medicaid, and Self-Funded plans.

Your role requires strong knowledge of regulatory standards, quality measures, and InterQual guidelines, with a focus on operational excellence and cross-functional collaboration with Medical and Compliance teams.