California Licensed Utilization Management Nurse Lead

Job Summary

Leading a team of Utilization Management Nurses, the full-time California Licensed Utilization Management Nurse Lead will review inpatient and prior authorization requests, ensuring timely processing and high-quality medical outcomes while working remotely.

Key responsibilities:

• Oversee the assignment of tasks to UM Nurses for timely completion of urgent items
• Act as a liaison between management and the team to ensure efficient case processing
• Participate in quality audits to assess case timeliness and program compliance

Required qualifications:

• Active, valid, and unrestricted LVN or RN license in California
• Minimum of 3 years of experience in concurrent review and/or prior authorization at a managed care organization
• Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program
• Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements
• Experience using MCG for at least 2 years