Supervisor, Utilization Management – RN

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

📋 Description

• Oversee the Clinical Review team responsible for Prior Authorization, Concurrent Review, and/or Retrospective Review.

• Manage the daily operations of the utilization management team.

• Track and monitor utilization management resources for efficiency, compliance, quality, and performance.

• Collaborate with the utilization management group to address complex care member concerns.

• Stay informed about utilization management regulations, accreditation standards, and best practices in the industry.

• Identify opportunities for process and quality enhancements in conjunction with the utilization management team and senior management.

• Provide education and resources to the utilization management team.

• Supervise clinical review nurses and ensure adherence to relevant guidelines, policies, and procedures.

• Develop and implement utilization management policies, procedures, and guidelines alongside senior management.

• Assess team performance and offer feedback regarding performance, objectives, and career development.

• Mentor and guide the utilization management team.

• Aid in the onboarding, hiring, and training of team members.

• Lead and advocate for change within the scope of responsibility.

• Perform additional duties as required.

• Adhere to all policies and standards.

⛳️ Requirements

• Graduate from an accredited nursing school or possess a Bachelor's degree with over 4 years of relevant experience.

• Preferred knowledge of utilization management principles.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure is mandatory.

• CA RN Licensure is required.

• Understanding of utilization management regulations, accreditation standards, and industry best practices.

• Capability to supervise clinical review nurses in prior authorization, concurrent review, and/or retrospective review.

• Ability to ensure compliance with relevant guidelines, policies, and procedures.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible working options including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• Equal opportunity employer dedicated to promoting diversity.