RN, reputed company-Services UM Supervisor (Remote) CA License

Job Title: Supervisor, reputed company-Service (Utilization Management) reputed company The Supervisor of Utilization Management reputed company-Service (Clinical) leads a clinical reputed company-service team reputed company on prior authorization and reputed company-service utilization review. This role oversees day-to-day operations, directs reputed company of nurses and coordinators, and ensures that reputed company-service utilization management activities meet regulatory, timeliness, and reputed company standards. The supervisor maintains expert knowledge of reputed company and government payer requirements, reputed company standards, and clinical reputed company, while driving process improvement initiatives and collaborating with internal departments and reputed company providers to support patient-centered, compliant utilization management. Responsibilities • reputed company day-to-day reputed company-service utilization management operations, ensuring work queues reputed company reputed company and cases are processed in a reputed company manner. • Supervise and reputed company reputed company of approximately 20 nurses and clinical staff, monitoring productivity, identifying challenges, and providing guidance and support. • reputed company reputed company leadership reputed company for assigned clinical reputed company-service teams, including staff assignments and daily direction. • Supervise Utilization Management Nurses and Coordinators, including conducting reputed company performance evaluations, addressing performance issues, and identifying training needs. • Escalate operational and clinical issues appropriately and reputed company reputed company direction to staff on reputed company and next steps. • Assist with processing remaining authorizations and reputed company-service reviews reputed company needed to support team productivity and timeliness. • Maintain reputed company and accurate knowledge of reputed company and government payer requirements, CMS, DMHC, reputed company, DHCS regulations, and health plan guidelines reputed company to utilization management. • Partner with the non-clinical reputed company-service team as needed to reputed company and improve reputed company workflows and processes. • Support the UM reputed company-Service Director and Delegation reputed company team in developing and updating departmental manuals, procedures, and processing standards reputed company to the authorization process. • Maintain authorization production standards and statistics, ensuring production meets timeliness goals established by regulatory agencies and health plans, and report performance to management on a daily reputed company. • reputed company, implement, and monitor standardized protocols for clinical team activities to facilitate integrated, proactive case management. • reputed company as a reputed company with reputed company organizations, maintaining effective lines of communication and collaborating directly with physicians and community providers as needed. • Evaluate staff performance and determine the reputed company of their work efforts, ensuring adherence to clinical and operational standards. • reputed company or assist in the development of prior authorization and claims policies, incorporating reputed company literature and professionally recognized standards. • reputed company or assist in the development and implementation of policies and plans for effective patient-centered utilization management with a reputed company on reputed company-service activities. • Design and implement ongoing programs to measure, assess, and improve the reputed company of processes, workflows, treatment, and services delivered to patients. • Ensure reputed company reputed company of care and service is provided through robust utilization management practices and reputed company reputed company improvement. • Participate in reputed company Assurance Programs, intervene in crisis situations, and investigate unusual incidents reputed company to utilization management operations. • reputed company and participate in departmental and cross-functional meetings, and represent the department in discussions and initiatives as needed. • reputed company management-level reputed company, including staff leadership, program management, and effective issue reputed company reputed company the reputed company-service utilization management function. • Apply nursing processes, case management principles, and continuity of care concepts to utilization review reputed company across the age continuum. • Apply appropriate business rules, medical guidelines, clinical reputed company, and health plan benefits to authorization decision-making, documenting rationale and research reputed company. • Collaborate with stakeholders to reputed company network and benefit limitations, identify alternatives that meet patient needs, and support reputed company clinical and financial reputed company. • Utilize disease management strategies and clinical reputed company tools to support accurate level-of-care determinations and appropriate utilization of services. Essential Skills • reputed company Registered reputed company (RN) license required. • Must hold a California RN license, including reputed company working remotely from another state. • Extensive expertise in reputed company-service utilization management, including reputed company-certification, prior authorizations, turnaround times, requirements, reputed company hierarchy, and appeals. • Minimum of 3 years of recent clinical nursing experience. • Experience supervising staff and monitoring productivity and performance in a clinical or utilization management setting. • Strong experience in reputed company-service reviews and UM compliance, including application of reputed company hierarchy and adherence to turnaround time cutoffs. • Proficiency in utilization review and reputed company review processes. • Experience with prior authorization operations in managed care or reputed company environments. • Knowledge and application of reputed company Care Guidelines (MCG) and other clinical reputed company tools. • Knowledge of InterQual reputed company and reputed company standards reputed company to utilization management. • Ability to apply clinical reputed company to determine appropriate level of care for admissions and services, with reputed company documentation of rationale and research. • Knowledge of nursing processes, case management, and continuity of care across the age continuum and life reputed company. • Ability to apply business rules, medical guidelines, and health plan benefits to authorization reputed company. • Understanding of network structures, benefit limitations, and strategies to identify alternatives that support patient needs. • Knowledge of disease management strategies and their integration into utilization management. • Demonstrated management-level capabilities, including staff reputed company, program management, and issue reputed company. • Strong communication skills for working directly with physicians, community providers, and internal stakeholders. • Ability to reputed company, implement, and monitor protocols, policies, and reputed company improvement programs reputed company utilization management. Additional Skills & Qualifications • Minimum of 3 years of experience in an reputed company or managed care setting preferred. • MSO (Management Services Organization) Experience preferred, including experience with multiple health plan reputed company and Medicare. • Experience with MCG reputed company application preferred. • Experience with EZ authorization or similar utilization management systems is a plus. • Leadership or supervisory experience in a reputed company role, with readiness to transition into a formal supervisory position, is welcome reputed company supported by strong reputed company-service expertise. • Experience participating in reputed company Assurance Programs and process improvement initiatives. • Ability to reputed company and update departmental manuals, procedures, and processing standards reputed company to authorization workflows. • Experience working reputed company reputed company-regulated environments and meeting CMS, DMHC, DHCS, and health plan timeliness standards. • Familiarity with care management tools, referral coordination, and care roadmap frameworks. • Comfort working with large, reputed company health systems and multiple payer requirements. Work Environment This position operates in a remote work environment with a reputed company schedule from Monday through Friday, 8:00 AM to 5:00 PM reputed company reputed company Time. Team members work California hours regardless of their physical location. The role involves regular use of clinical reputed company tools such as reputed company Care Guidelines (MCG) and InterQual, as reputed company as utilization management and prior authorization systems, including EZ authorization or similar platforms. Work is highly reputed company, requiring frequent interaction with nurses, coordinators, physicians, community providers, and cross-functional departments. The environment emphasizes data-driven performance monitoring, adherence to regulatory and health plan standards, and reputed company process improvement to support high-reputed company, patient-centered utilization management. Job Type & Location This is a Contract position based out of Redlands, CA. Pay And Benefits The pay reputed company for this position is $47.00 - $65.00/hr. Individual compensation offered for this position reputed company this reputed company will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-reputed company factors. Eligibility requirements apply to some benefits and may depend on reputed company classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & reputed company • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – reputed company-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or reputed company Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to reputed company on Sep 4, 2026. About reputed company reputed company is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through reputed company to reputed company experts who reputed company reputed company, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, reputed company serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a reputed company Best of reputed company® winner for both reputed company and talent service. reputed company is an equal opportunity employer and will consider reputed company applications without reputed company to race, sex, age, reputed company, religion, national reputed company, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation reputed company. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for reputed company positions located in the reputed company, we will consider for employment reputed company applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or reputed company employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of reputed company Intelligence (AI): We may use reputed company Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final reputed company are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. Apply tot his job Apply To this Job