California RN Supervisor

Job Summary

Supervising a remote utilization management team, the full-time California RN Supervisor will oversee prior authorization, concurrent review, and retrospective review processes, ensuring compliance and quality care for California members while working Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time.

Key responsibilities:

• Monitors and tracks utilization management resources to ensure adherence to performance and compliance standards
• Collaborates with the team to resolve complex member care issues and identifies opportunities for process improvements
• Provides coaching, training, and feedback to the utilization management team to enhance performance and quality standards

Required qualifications:

• Current California RN license
• Graduate of an accredited nursing school or a Bachelor's degree with 4+ years of related experience
• 3-5 years of direct experience in managing appeals and knowledge of utilization management principles in a managed care environment
• Knowledge of regulations and accreditation standards related to utilization management
• Ability to obtain Certified Managed Care Nurse (CMCN) certification within 1.5 years for specific roles