Lead Utilization Management Nurse, Inpatient

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

📋 Description

• Reviews reports to delegate tasks to UM Nurses for the completion of time-sensitive items.

• Functions as a key liaison between management and the team to guarantee timely processing of new cases.

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

• Communicates effectively with the Utilization Management leadership team regarding operational matters.

• Provides assistance with team coverage plans and operational support as necessary.

• Collaborates with leaders to enhance and refine processes and workflows.

• Serves as a resource for the team, members, providers, and community partners.

• Oversees the onboarding and training of new hires, including mentoring and coaching UM Nurses.

⛳️ 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 requirements.

• Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program.

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

🏝️ Benefits

• Health insurance

• 401(k) matching

• Paid time off

• Flexible work arrangements