California Licensed Utilization Management Supervisor

Job Summary

Supervising a remote team of clinical professionals, the full-time California Licensed Utilization Management Supervisor will oversee Prior Authorization, Concurrent Review, and Retrospective Review processes to ensure quality care for members while leading day-to-day activities of the utilization management team.

Key responsibilities

• Monitor and track utilization management resources to ensure compliance with performance and quality standards
• Collaborate with the utilization management team to address complex member care issues and identify process improvement opportunities
• Provide coaching, guidance, and training to the utilization management team to enhance performance and adherence to policies

Required qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree
• 4+ years of related experience in utilization management
• Current RN license required, with California RN license specifically needed
• Knowledge of utilization management principles preferred