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...