Utilization Management Nurse

Valir Health•Alexandria, VA

About The Position

Job Summary: The RN Utilization Management Nurse, under the general direction of the PACE Clinic Manager, is responsible for performing clinical utilization management activities, ensuring appropriate delivery of care, compliance with regulatory requirements, and efficient use of healthcare resources. This role combines direct clinical review and care coordination with limited short-term supervisory responsibilities for clinical staff.

Requirements

Strong knowledge of utilization management, case management, and population health concepts.
Excellent verbal and written communication skills.
Strong interpersonal and customer service skills, with the ability to build trust and rapport with staff, participants, and families.
Ability to navigate communications with large medical networks, including hospitals, specialist offices, and others.
Analytical and problem-solving skills with attention to regulatory compliance.
Ability to function effectively in a fast-paced and agile environment.
Proficiency with Microsoft Office Suite and electronic health record systems.
Current Registered Nurse (RN) license (required).
CPR/BLS certification (required).
Prior experience in utilization management, case management, or quality review (required).
At least 2 years of clinical nursing experience (PACE, geriatrics, or aging care management preferred).