Nurse Manager, Utilization Management – Physical Health

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Lead teams focused on utilization management and supervise daily authorization processes, which encompass intake, coordination of reviews, and determination processing.

• Oversee staff workload to guarantee timely execution of authorization tasks.

• Track turnaround times, ensure decision accuracy, and maintain high documentation quality throughout the team.

• Assess cases and decisions to confirm the consistent application of clinical criteria and policies.

• Offer clinical guidance and support to staff on complex or escalated authorization matters.

• Address provider concerns, complaints, and escalations related to authorizations.

• Supervise utilization management operations, including authorization and clinical review workflows.

• Evaluate performance and direct staff to ensure timely, precise determinations and uniform review standards.

• Travel within the designated catchment area as necessary.

⛳️ Requirements

• Associate's degree in Nursing along with three (3) years of experience as a Registered Nurse (RN) in utilization review, utilization management, or prior authorization, which includes experience in clinical acute inpatient care (ER, ICU, Med-Surg), post-acute care, health plan operations, and/or behavioral health; OR a Bachelor's degree in Nursing with one (1) year of RN experience in the same fields; OR an equivalent combination of education and experience.

• Current North Carolina Licensure as a Registered Nurse (RN).

• A valid driver's license.

• Must reside within North Carolina.

• Ability to travel within the catchment area as required.

• Must successfully pass a drug test as a condition of employment.

• Preferred supervisory experience of two (2) or more employees.

• Previous experience with Medicaid is preferred.

• Familiarity with InterQual guidelines and/or NC Medicaid Clinical Coverage Policies is preferred.

• Resume must include employer names, dates of service, average weekly hours worked, key responsibilities, education details, and licensure/certification information as applicable.

🏝️ Benefits

• Collaborative, mission-driven work environment.

• Competitive benefits package.

• Work-from-home options available for most positions.

• Flexible work schedules for certain positions, subject to management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays during your first year.

• Participation in the NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.