Remote Utilization Review Rn Jobs in High Point, NC

Job Description:

The RN Lead, Care Management is an experienced nurse leader responsible for overseeing the day-to-day operations of a care delivery team and ensuring frontline care aligns with Cityblock's clinical standards. This role provides direct supervision of an integrated care team and leads the onboarding, training, and ongoing performance management of RNs and CHPs, while actively supporting individual professional development. The RN Lead also oversees care delivery workflows, resolves daily operational challenges, and collaborates closely with clinical and operational leaders to identify and escalate issues as needed.

People Leadership and Performance Management: Oversees the day-to-day activities of the care management team (RNs and CHPs), monitoring performance and reporting to ensure assigned key performance indicators are met. Conducts regular check-ins and performance reviews to reinforce expectations, support effective member panel management, and provide ongoing feedback. Delivers timely coaching and clinical guidance, proactively addressing issues while fostering continuous professional learning, engagement, and empowerment. Leads onboarding and orientation for new hires to ensure clinical readiness and alignment with team workflows.

Clinical Oversight: Provides oversight to ensure member needs are addressed through appropriate enrollment in programs and pathways, effective care planning, and timely task execution, supporting member progress toward graduation to lower levels of care management. Conducts regular audits, including call monitoring and chart reviews, to ensure compliance with Cityblock protocols and clinical standards.

Operational Oversight: Partners closely with operational leadership to ensure the team has the necessary tools, supplies, and technical access to perform their duties efficiently, proactively escalating barriers and resource gaps as needed.

Cross Functional Collaboration: Facilitates effective collaboration across RN, CHPs, Providers, Behavioral Health Specialists, Pharmacists, and other care team roles. Works with care team members to ensure clear communication and handoffs across disciplines to support seamless member care.

Change Management: Leads pods through operational, clinical, and technology changes, ensuring clarity, adoption, and sustained performance. Solicits frontline feedback to help to identify opportunities to streamline processes, reduce friction, and improve the staff and member experience.

Education and Experience

• Clinical Credential: Active, unrestricted Registered Nurse (RN) license in good standing in the state operating in.

• Experience: 3+ years clinical experience

• Management Depth: 1+ years in a lead or supervisory capacity

• Expertise: Ability to supervise daily activities and solve departmental problems using established procedures.

Skills and Competencies

• Interpersonal Skills: Creates psychological safety for direct reports and builds team capacity through coaching. Supports the professional development of team members through coaching.

• Problem Solving: Resolves daily operations issues, guided by policy and processes.

• Results Driver: Communicates team goals clearly and tracks team productivity. Has solid functional knowledge and understands how team activities support department goals.

Success Metrics

• Clinical Quality: Meeting or exceeding defined metrics for the assigned vertical.

• Operational Efficiency: Successful implementation of standardized care workflows and technology adoption (e.g., AI tools) with assigned team.

• Leadership Health: Retention of direct reports and high engagement scores within the team; evidence of successful internal promotions.

We take into account an individual's qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company's equity program, paid time off, including vacation and sick leave. The actual offer will be at the company's sole discretion and determined by relevant business considerations, including the final candidate's qualifications, years of experience, skillset, and geographic location.The expected salary range for this position is:

Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.