What are the responsibilities and job description for the RN Manager Utilization Management position at Everly Talent?
A well-established, physician-led healthcare organization in Nassau County, NY is seeking an experienced Manager of Clinical Utilization Management to provide leadership and operational oversight for its inpatient and outpatient utilization management teams. This individual will oversee prior authorization, concurrent review, and care coordination functions while driving clinical quality, operational efficiency, and cost-effective healthcare delivery.
The ideal candidate is an experienced RN leader with a strong background in managed care utilization management, clinical operations, and performance improvement. This is an excellent opportunity to collaborate with physician and clinical leadership, implement strategies to improve patient outcomes, and lead a team within a stable, growing healthcare organization.
Key Responsibilities:
- Lead inpatient and outpatient utilization management teams, including prior authorization and concurrent review functions
- Supervise and develop clinical staff while monitoring productivity, quality, and operational performance
- Analyze utilization trends and implement strategies to reduce avoidable admissions, readmissions, and healthcare costs
- Ensure compliance with MCG clinical criteria, payer guidelines, and CMS/NCQA regulatory standards
- Collaborate with Medical Directors, Case Management, Pharmacy, and clinical leadership to improve care coordination and patient outcomes
- Oversee quality improvement initiatives, audits, workflow optimization, and departmental reporting
- Participate in a rotational management on-call schedule for after-hours and weekend coverage
Requirements:
- Active, unrestricted Registered Nurse (RN) license required
- Bachelor of Science in Nursing (BSN) required; Master's degree preferred
- Minimum 5 years of clinical nursing experience
- Minimum 3 years of supervisory or leadership experience
- Utilization Management experience within a managed care environment required
- Strong understanding of MCG guidelines, CMS, NCQA, and Medicare, Medicaid, and Commercial payer requirements
- Inpatient Utilization Management and prior authorization experience preferred
- Strong analytical, communication, and clinical leadership skills
- Experience leading interdisciplinary teams and quality improvement initiatives preferred
Compensation: $130,000–$150,000 annually plus bonus
Salary : $130,000 - $150,000