[Hiring] Utilization Management Manager @IntusCare

Role Description

The Utilization Management (UM) Manager is fully accountable for the performance of the UM nurse team supporting a Program of All-Inclusive Care for the Elderly (PACE). This role owns end-to-end delivery of the UM program, including:

• Meeting all service-level agreements (SLAs)
• Ensuring consistent application of policies, procedures, and clinical decision support criteria
• Driving continuous improvement across the UM function

The UM Manager spends approximately 25% of their time working directly on UM cases and provider disputes and the remaining 75% managing team performance, service quality, staffing, coaching, and cross-functional coordination.

Qualifications

• Current, active Registered Nurse (RN) license in good standing
• 7+ years of utilization management experience, including experience in risk-based, integrated care models
• 5+ years of direct people-management experience leading a team of clinical reviewers or UM nurses
• Demonstrated experience owning and improving inter-rater reliability, QA programs, and consistent application of clinical decision support criteria
• Strong data literacy—able to use dashboards and analytics to diagnose performance gaps
• Proven ability to manage competing priorities in a fast-paced, performance-driven environment
• Excellent written and verbal communication skills

Requirements

• Hold full accountability for UM team performance, including meeting or exceeding all program SLAs
• Establish, monitor, and report on individual and team performance metrics
• Ensure consistent application of PACE service authorization policies
• Design and lead ongoing quality assurance (QA) and inter-rater reliability activities
• Manage staffing, scheduling, workload distribution, and case assignment
• Recruit, onboard, and develop UM nurses
• Foster a culture of accountability, collaboration, psychological safety, and continuous improvement
• Maintain and update UM policies, procedures, workflows, and job aids
• Partner with the contracted IntusCare Contracted Physician
• Use data analytics to monitor care patterns and translate findings into targeted improvement initiatives
• Prepare and present program performance reporting to internal leadership and PACE client stakeholders
• Personally handle a defined caseload of UM reviews and provider disputes
• Lead the provider dispute process on complex or escalated cases
• Partner with PACE organizations, Medical Directors, IDTs, and provider networks
• Facilitate education, training, and cross-functional collaboration
• Serve as one of the primary points of contact for IntusCare UM program performance

Benefits

• The base salary for this role is $115,000
• Final compensation will be determined based on experience, skills, and organizational needs

Company Description

IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant.