California Licensed Utilization Management Supervisor
Job Summary
Supervising a team of clinical reviewers, the full-time California Licensed Utilization Management Supervisor will oversee prior authorization, concurrent review, and retrospective review processes, ensuring compliance and quality standards while working remotely.
Key responsibilities
- Monitor and track utilization management resources to ensure adherence to performance and compliance standards
- Collaborate with the team to resolve complex member care issues and identify opportunities for process improvements
- Provide coaching, guidance, and training to the utilization management team, ensuring adherence to quality standards
Required qualifications
- Graduate of an Accredited School of Nursing or Bachelor's degree
- 4+ years of related experience in utilization management
- California RN Licensure required
- Knowledge of utilization management principles preferred
Complete Job Description
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