Lead Utilization Management Nurse, California LVN/RN License

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluating requests for inpatient and prior authorization services for all members of the plan.

• Collaborates with UM leaders and healthcare providers to ensure prompt processing of referrals.

• Supervises and supports the team of UM Nurses with clinical decision-making responsibilities.

• Engages in departmental quality audits and vendor assessments to evaluate the timeliness of cases.

• Works alongside other leaders in the department to enhance processes and workflows.

• Directs, initiates, and manages multiple projects concurrently in a collaborative environment.

⛳️ Requirements

• A minimum of three (3) consecutive years of relevant experience in concurrent review and/or prior authorization within a managed care organization.

• At least two (2) years of experience utilizing MCG.

• Familiarity with Medicare Managed Care Manuals and CMS regulatory standards.

• Strong written and verbal communication skills.

• Must possess and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact).

🏝️ Benefits

• Competitive salary.

• Health insurance.

• Opportunities for professional development.

• Paid time off.