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Responsibilities
IntusCare is looking for a Utilization Management Manager to lead our UM nurse team supporting Programs of All-Inclusive Care for the Elderly (PACE). This isn't just a management role. You'll spend about 75% of your time leading, coaching, and scaling a high-performing UM team and 25% staying hands-on with complex case reviews and provider disputes, so you never lose touch with the clinical work.What you'll own:Full accountability for UM team performance and SLAsQuality assurance & inter-rater reliability programsStaffing, coaching, and professional development for UM nursesComplex case reviews and provider dispute resolutionData-driven process improvement across the UM functionWhat you bring:Active RN license (any state)7+ years leading UM Teams for payers, including Medicare Advantage line of business.5+ years leadership experienceExperience with risk-based/integrated care models3+ years directly managing clinical reviewers or UM nursesStrong data literacy and a continuous-improvement mindsetIf you're ready to lead a team that's transforming care for dual-eligible seniors, we'd love to hear from you.
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