Utilization Management Director, RN Required

Northeast Georgia Health System

Director of Utilization Management overseeing financial integrity and patient outcomes at Northeast Georgia Health System. Leading collaborative efforts with hospital leadership and enhancing quality reporting and hospital resources.

Posted 4/17/2026full-timeRemote • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Oversee day-to-day operations of the Utilization Management Department
Ensure compliance with payer requirements and regulatory standards
Monitor and analyze key performance indicators (KPIs)
Recruit, train, and manage a high-performing UM team
Manage departmental budgets and financial responsibility
Develop and implement performance metrics

Requirements

What you’ll need

Registered Nurse license
UR specific certification preferred (CCM, ACM, CPUR)
Bachelors Degree
Minimum of 7 years UR experience
2 years progressive Revenue Cycle leadership experience
Proven ability to lead teams and manage budgets
Strong ability to educate and influence on UM best practices
Experience in data analysis and performance improvement strategies
Expertise in medical necessity criteria and payer regulations

Benefits

Comp & perks

Health insurance
401(k) retirement plans
Paid time off
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisperformance improvement strategiesbudget managementkey performance indicators (KPIs)medical necessity criteriapayer regulations

Soft Skills

leadershipteam managementeducationinfluence

Certifications

Registered Nurse licenseCCMACMCPUR