RN Manager Utilization Review - Full Time - Days

Location: Manchester, New Hampshire, United States; onsite, first shift, full time

Company

hirify.global's Elliot Health System Care Coordination Department supports coordinated, patient-centered care through care management, discharge planning, and patient advocacy.

What you will do

• Lead utilization review staff and operations, ensuring timely and compliant level-of-care determinations and clinical submissions.
• Provide second-level clinical reviews and escalation support for complex cases, denials, and appeals.
• Oversee the use of InterQual or equivalent criteria and promote high-quality clinical documentation.
• Direct denial prevention and mitigation strategies, monitor utilization indicators, and implement corrective action plans.
• Partner with physician leadership, revenue cycle, finance, quality, compliance, case management, and external payers.
• Lead data-driven quality improvement initiatives for utilization management, care coordination, patient flow, and payer communication.

Requirements

• Graduate of an accredited nursing program with a Bachelor's degree in Nursing or higher required; a master's degree is preferred.
• Demonstrated knowledge of utilization review and InterQual required.
• Knowledge of denials management, case management, medical necessity determination, level-of-care criteria, denial prevention, and appeals across payers.
• Leadership, people management, clinical decision-making, communication, relationship-building, analytical, and process improvement skills.
• Active New Hampshire or Compact State RN license required.
• CCM or ACM certification and managerial experience are preferred.

Culture & Benefits

• Health, dental, prescription, and vision coverage for full-time and part-time employees.
• Short-term and long-term disability, life, and pet insurance.
• Tuition reimbursement.
• 403(b) retirement savings plan.
• Continuous earned time accrual.