Position OverviewShearwater Health is seeking an experienced RN Program Manager to lead the clinical and operational delivery of the Client's Utilization Management program.
This is a hands-on leadership role for an RN who understands utilization management and can translate client requirements into reliable day-to-day operations. The Program Manager will provide leadership to the clinical delivery team, coordinate staffing and readiness, monitor operational and quality performance, resolve issues, and serve as a key clinical and operational liaison with Client.
This is not a traditional project management position. The Program Manager is an operations leader accountable for the successful delivery of the program.
In the Program Manager, RN role, you will be responsible for:Leading the Operation
- Provide day-to-day clinical and operational leadership for the Client program.
- Lead the clinical delivery team and establish clear accountability for performance.
- Monitor staffing, capacity, workload, productivity, service delivery, and operational risks.
- Ensure appropriate leadership coverage and clinical escalation pathways.
- Identify barriers to performance and drive timely resolution.
Serving as a Trusted Client Partner
- Serve as a key operational and clinical liaison between Client and Shearwater Health.
- Coordinate Shearwater resources supporting the program.
- Lead discussions involving operations, staffing, readiness, clinical workflows, quality, and service performance.
- Facilitate timely information exchange between Client and internal teams.
- Own operational issue escalation and follow-through.
Providing Clinical Leadership
- Provide RN leadership and clinical guidance to the utilization management operation.
- Support clinical decision-making and appropriate escalation when cases require additional clinical review.
- Reinforce consistent application of client policies, clinical criteria, documentation requirements, and escalation procedures.
- Partner effectively with medical directors and other designated clinical resources.
- Maintain the clinical credibility necessary to support and lead an RN-based operation.
Developing the Team
- Provide leadership and direction to Team Leads and clinical staff.
- Partner with Workforce Management and Clinical Operations on staffing and capacity planning.
- Support hiring, onboarding, retention, and development of team members.
- Partner with Training and Quality to ensure new clinicians are ready before independent production.
- Identify performance opportunities and support coaching and remediation.
Driving Quality and Improvement
- Partner with Quality, Training, Clinical Operations, and client stakeholders to maintain strong clinical quality.
- Monitor quality and performance trends and ensure identified issues are addressed.
- Support audits, remediation, and performance-improvement activities.
- Identify opportunities to simplify workflows, improve efficiency, and strengthen operational controls.
- Promote a culture of accountability, clinical integrity, and continuous improvement.
Qualification Requirements:- Current, active, unrestricted Registered Nurse license in the United States.
- Ability to obtain and maintain an active Michigan RN license.
- Clinical RN experience with sufficient depth to provide credible leadership to an RN utilization management team.
- Utilization management, utilization review, managed care, payer, or similar clinical operations experience.
- Demonstrated people or clinical-operations leadership experience.
- Strong clinical judgment, critical thinking, and problem-solving skills.
- Ability to translate client requirements into clear operational expectations.
- Strong written, verbal, and client-facing communication skills.
- Ability to lead through change, ambiguity, and competing priorities.
Preferred Qualifications- Current Michigan RN license.
- Hands-on experience using InterQual clinical criteria in utilization management or utilization review.
- MCG or comparable evidence-based clinical criteria experience.
- Health plan or managed-care experience.
- Leadership experience within utilization management or utilization review operations.
- Experience with prospective/prior-authorization, concurrent, and retrospective review.
- Client-facing healthcare operations experience.
- Bachelor of Science in Nursing (BSN).
Employee Benefits:- A competitive compensation structure
- Comprehensive health insurance
- 401(k)
- Paid vacation time
- The opportunity to build your career in a rewarding and unforgettable way
