Virginia Licensed RN Manager

Job Summary

A company is looking for a Manager of Clinical Health Services, UM Prior Authorization.

Key Responsibilities

• Lead and manage the prior authorization team, including hiring, training, and performance evaluations
• Ensure timely review and processing of prior authorization requests for medical services and medications
• Monitor productivity and quality metrics; implement process improvements to enhance efficiency and accuracy

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license
• Minimum of 5 years of clinical experience
• Minimum of 3-5 years of utilization management or prior authorization experience
• Minimum of 3 years of leadership experience, including direct supervision of clinical or operational staff
• Strong knowledge of Medicaid programs and regulatory compliance