Hybrid/Remote System Nurse Director Utilization Management

Large health system (over 8 hospitals) looking for a System Nurse Director Utilization Management! Full Relocation!

EPIC Electronic Health Record System Utilization Management workflows experience is a Must!

Director System Utilization Management (UM) provides strategic and operational leadership for utilization review, and resource management functions across the health system. This role ensures appropriate use of healthcare services, regulatory compliance, and optimal reimbursement, across all facilities and service lines. Oversees day-to-day utilization review operations, establishes standardized processes and best practices, and drives organizational alignment to promote cost-effective care. Working collaboratively with clinical, operational, and revenue cycle leadership, this position advances performance improvement initiatives, reduces denials, and strengthens financial and regulatory outcomes across the system.

Qualifications:

• Active RN license
• Certification in Case Management and/or Utilization Management preferred
• 7–10+ years of progressive leadership experience in Utilization Management or Case Management.
• Experience in multi-hospital or system-level leadership preferred.
• Strong knowledge of payer requirements, CMS regulations, and accreditation standards.
• In depth working knowledge and experience of the EPIC Electronic Health Record System Utilization Management workflows, WQs and data reporting capabilities.