California Licensed Medical Review Manager

Job Summary

To lead multidisciplinary teams in delivering high-quality medical necessity reviews, the full-time California Licensed Medical Review Manager will oversee operations, ensure regulatory compliance, and drive continuous improvement while working remotely with occasional in-office requirements.

Key responsibilities

• Provides strategic leadership for teams responsible for medical necessity determinations and clinical quality reviews
• Ensures compliance with regulatory, accreditation, and contractual requirements governing medical review operations
• Develops and manages departmental budgets while forecasting workload demand and ensuring resource allocation

Required qualifications

• Master's degree in business administration, engineering, information systems, or a related field preferred
• Twelve or more years of support services, project, or program experience
• Eight or more years of leadership or supervisory experience
• Experience working with technology industry products and operating systems
• Experience in proposal development and operational planning