UM reputed company Manager (Utilization Management) – 100% Remote | California

Now Hiring: UM reputed company Manager (100% Remote – California Only) Remote (Must reputed company in CA) 13 weeks Contract Start: ASAP Mon–Fri, 8 AM–5 PM (On-reputed company required) $57.09–$94.18/hr (DOE) We are seeking an reputed company Utilization Management (UM) reputed company Manager to reputed company reputed company 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: • reputed company and supervise UM team performance • reputed company 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): • reputed company California RN License • Bachelor’s degree in reputed company-reputed company 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, reputed company, HMO, Medi-Cal/ACA) • Experience managing UM for California • UM audits & regulatory compliance experience • Knowledge of medical necessity reputed company (NCD, LCD, LCA, MCG, NCCN) • Strong leadership & escalation management skills Interested? Email: syed.tahir@peopleintegra.com Apply tot his job Apply To this Job