Job Description
Now Hiring: UM Nurse Manager (100% Remote – California Only)
Remote (Must reside in CA)
13 weeks Contract
Start: ASAP
Mon–Fri, 8 AM–5 PM (On-call required)
$57.09–$94.18/hr (DOE)
We are seeking an experienced Utilization Management (UM) Nurse Manager to lead a team of 15 (RNs & non-clinical staff). This role serves as the UM SME, manages escalations, ensures regulatory compliance, and oversees prior authorization review processes.
- Key Responsibilities:
- Lead and supervise UM team performance
- Oversee prior authorization reviews (ambulatory & health plan)
- Manage escalations and serve as UM Subject Matter Expert
- Ensure compliance with Federal, State, URAC & NCQA regulations
- Participate in audits and UM committee meetings
- Drive process improvement initiatives
- Collaborate with providers, case management & leadership
- Requirements (MUST HAVE):
- Active California RN License
- Bachelor’s degree in healthcare-related field
- 3–5+ years Nursing Management experience
- 5–10+ years total nursing experience
- Strong Prior Authorization experience (ambulatory & health plan required)
- Health Plan experience (Medicare, Medicare Advantage, Commercial, HMO, Medi-Cal/ACA)
- Experience managing UM for California
- UM audits & regulatory compliance experience
- Knowledge of medical necessity criteria (NCD, LCD, LCA, MCG, NCCN)
- Strong leadership & escalation management skills
Interested? Email: [email protected]
Apply Now
Apply Now