Remote Utilization Management Nurse Jobs in Rhode Island

Pay Range:

Please emailHR_Talent_AcquisitionTeam@bcbsri.orgif you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We're dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters:

Lead end-to-end improvement of a (customize: business journey or domain), delivering measurable gains invalue and experience. Work across business, data & analytics, research & discovery, and engineering partners to design and implement capabilities that combinetechnology, workflow redesign, and operating model change. The role is aligned to a particular business unit and/or customer journey, and is responsible for delivering strong, measurable outcomes for that space.

What you will do:

• Lead, develop, promote and champion solutions that solve the most complex business needs, as well as align with transformation strategy. Identify options based on the business strategy, recommend the best solution that fits the business need, and gain consensus from business associates.
• Proactively identify and prioritize the highest impact opportunities across processes, policies, and systems within a defined domain.
• Translate opportunity into a focused, sequenced roadmap of capabilities and solutions with expected impact.
• Partner closely with business leaders, AI discovery leads, engineers, and analytics teams to design integrated solutions. Ensure solutions address both technology and process, to drive meaningful change.
• Work with full-stack, forward-deployed engineering teams to deliver scalable solutions using modern development practices.
• Lead rapid pilots and iterative rollout of improvements, adjusting based on real-world performance.
• Enable adoption, behavior change, and alignment with business partners to ensure solutions are embedded within day-to-day operations.
• Ensure delivered improvements result in sustained, measurable cost and performance gain.
• Responsible for the measurement and delivery of financial and operational outcomes. Ownership of both the value and experience improvements.
• Maintain alignment across stakeholders and manage tradeoffs to keep work focused on highest-value outcomes.
• May work on integration and customization of products/platforms, inclusive of AI/agentic solutions.
• Perform other duties as assigned.

What you need to succeed:

• Five to seven years in product, operations, or transformation roles
• Experience working across business and technology teams
• Experience in health insurance preferred
• Strong problem-solving and prioritization skills
• Proven ability to drive measurable results in complex environments
• In depth knowledge of the healthcare (or related) industry, of technology, and of processes, such as cross-functional business processes for major operational areas, project management, vendor management, and project life cycle, as well as a broad understanding of government and Blue Cross Blue Shield Association regulations,
• Business thinking and highly strategic in order to define practical solutions that align with corporate strategy while requiring the least amount of funding and people to implement.
• Strong business acumen and political savvy
• Ability to lead and manage initiatives
• Ability to collaborate while dealing with complex situations
• Ability to think creatively and to drive innovation
• Ability to motivate, lead and inspire a diverse group to a common goal/solution with multiple stakeholders
• Ability to convert business strategy into action-oriented objectives and measurable results
• Strong negotiating, influencing, and consensus-building skills
• Ability to mentor, coach and provide guidance to others

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visitwww.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.