Utilization Management Nurse

Role Overview

The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual partners closely with PACE Interdisciplinary Teams, Medical Directors, and provider networks to review service utilization, guide care decisions and support timely, appropriate transitions across care settings.

What You Will Do

Rigorous adherence to PACE program service authorization policies, ensuring that participant care and related claims are reasonable and necessary for diagnosis or treatment and consistent with PCP coordination decisions. Active involvement in various aspects of the utilization management process, including concurrent review of all hospital admissions, subacute and SNF admissions, and coordination and review of all other services delivered by contracted providers.

Why It Might Be a Fit

3 to 5 years of utilization management experience, current RN license, proven experience working in risk-based integrated models of care, ability to use data to drive decisions, strong strategic thinking, problem-solving, and decision-making skills, excellent communication and leadership abilities.

Requirements

• 3 to 5 years of utilization management experience
• Current RN license
• Proven experience working in risk-based integrated models of care
• Ability to use data to drive decisions
• Strong strategic thinking, problem-solving, and decision-making skills
• Excellent communication and leadership abilities

Benefits

• Competitive salary
• Equity package
• Comprehensive benefits including health, dental, and vision insurance
• Collaborative, inclusive, and dynamic work environment
• Opportunities for professional growth and development