California Licensed Utilization Management RN

Job Summary

Leading the Utilization Management team, the fully remote California Licensed Utilization Management RN will oversee daily operations, assist in reviewing prior-authorization requests, and collaborate with various stakeholders to enhance care delivery for senior participants.

Key responsibilities

• Direct oversight of day-to-day operations within the designated Utilization Management team
• Assist in reviewing prior-authorization requests for medical necessity and appropriateness
• Identify and develop orientation and competency development for staff involved in processing and reviewing authorizations

Required qualifications

• Minimum of three (3) years of relevant clinical nursing experience
• Strong preference for prior PACE experience
• Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members