Rn Mgr Utilization Mgmt

Rn Mgr Utilization Mgmt Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services. Primary duties may include, but are not limited to: Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions. Coordinates service delivery to include member assessment of physical and psychological factors. Partners with providers to establish short and long term goals that meet the members needs, functional abilities, and referral sources requirements. Identifies members with potential for high risk complications. Reviews benefit systems and cost benefit analysis. Evaluates medical, mental health and substance abuse service for cost containment. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications: Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background. We need an aggressive UM manager quick with acute inpatient services including NICU, ICU, CCU and Transplants. We need current high volume experience with Maryland hospitals, on straight medical conditions. Current unrestricted RN license in the state of Maryland required. Prior managed care or insurance experience preferred. Computer literate - MS Word, Excel, Outlook Knowledge of Milliman or Interqual criteria preferred Prior experience managing clinical staff required.

Created: 2026-04-04