Senior Manager, Utilization Management (RN) - Hybrid / Houston, TX

The Utilization Management Leader oversees clinical and nonclinical team operations, including areas such as case management, concurrent review, prior authorization, call center support, and letter review. This role is responsible for team performance, productivity, quality outcomes, regulatory compliance, and staff development.

Key responsibilities include monitoring operational metrics, managing daily staffing needs and workloads, conducting audits, facilitating clinical rounds, supporting onboarding and training, and resolving authorization issues. This leader partners across departments to improve processes, enhance efficiencies, and support organizational goals and member outcomes.

The ideal candidate is a collaborative, solution-oriented leader with strong knowledge of utilization review processes, medical necessity guidelines (MCG and/or InterQual), and managed care operations. This position requires the ability to work independently, manage competing priorities, and perform effectively in a fast-paced environment.

Qualifications:

• RN required; BSN preferred

• Current unrestricted Texas RN license required

• MBA, MHA, or MSN preferred

• 3-5 years of managed care experience

• 3-5 years of leadership or supervisory experience

• Experience with Medicaid and/or Commercial lines of business preferred

• Knowledge of utilization review, census management, and medical necessity guidelines required

• CCM certification preferred

• Proficiency in Microsoft Office applications required

Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs.

Community is an Equal Opportunity Employer.

Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement.

To learn more, contact:

Sunita Saksena, Talent Attraction Partner II
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