Key responsibilities • Lead, coach, and support the Central UR nurses and Insurance Specialists; manage assignments, workflow priorities, and staff performance. • Ensure timely initial and continued-stay reviews, authorization follow-up, payer communication, and escalation of cases at risk for denial. • Partner with physician advisors and care teams on level-of-care questions, peer-to-peer reviews, potential account downgrades, and clinical appeals. • Analyze denial, appeal, authorization, and UR performance data to identify trends and lead corrective action. • Work with hospital case management, medical, nursing, and revenue cycle leaders to resolve barriers and improve care progression. • Identify recurring payer and Independent Review Organization issues and share findings with Managed Care Contracting and appeals leadership. • Develop clear workflows, education, and tools in response to performance gaps, payer requirements, and regulatory changes. • Monitor improvement plans and help teams sustain results across AHS hospitals. Required • Graduate of an accredited school of nursing with a current Registered Nurse license in the applicable state. • Bachelors degree in nursing, • Advanced degree in business, or health care administration preferred. • Leadership experience in an acute care setting. • Experience in acute care case management or utilization review. • Strong clinical judgment, communication, data analysis, and team leadership skills. Preferred • ACM-RN or CCM certification. • Experience with payer authorizations, clinical denials and appeals, and physician advisor workflows. • Case management training through a professional organization.