Utilization Management Director - Rn Required - Remote

NGHS

Northeast Georgia, US
Registered nurse licensure required
7 years utilization review experience
2 years revenue cycle leadership
The Director of Utilization Management is responsible for leading UM functions to ensure correct status assignment and optimize reimbursement while minimizing denials

Job Summary

  • The Director of Utilization Management is responsible for leading UM functions to ensure correct status assignment and optimize reimbursement while minimizing denials.
  • This role serves as a key liaison between clinical and financial operations, ensuring seamless integration of documentation integrity with utilization management.
  • The position requires recruiting, training, and managing a high-performing UM team while fostering strong relationships with hospital executives, physicians, and payers.

Matching Summary

The Director of Utilization Management is responsible for leading UM functions to ensure correct status assignment and optimize reimbursement while minimizing denials.

Skills & Requirements

Must-have

  • Registered Nurse licensure required
  • 7 years utilization review experience
  • 2 years revenue cycle leadership
  • Physician education and influence
  • KPI tracking and data analysis

Nice-to-have

  • Master's degree in nursing preferred
  • CCM, ACM, or CPUR certification
  • Strategic initiative implementation
  • Budget management expertise
  • Collaborative interdisciplinary teamwork

Key Requirements

  • Registered Nurse (RN) license
  • Minimum 7 years UR experience
  • Minimum 2 years Revenue Cycle leadership
  • Bachelor's degree required
  • Master's degree preferred

Work Rights

Not specified

Tailored Resume

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