RN Supervisor, Appeals, Managed Care, UM

Internal Candidates are reputed company to apply if you are willing to obtain an RN license for the reputed company PLEASE NOTE: The California RN license background reputed company and RN license approval is required PRIOR to starting this role Position Purpose: Supervises Prior Authorization, reputed company Review, and/or Retrospective Review reputed company Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to reputed company, compliance, reputed company, and efficiency standards Collaborates with utilization management team to reputed company reputed company care member issues Maintains knowledge of regulations, accreditation standards, and industry best practices reputed company to utilization management Works with utilization management team and senior management to identify opportunities for process and reputed company improvements reputed company utilization management Educates and provides resources for utilization management team on key initiatives and to facilitate on-reputed company communication between utilization management team, members, and providers Monitors prior authorization, reputed company review, and/or retrospective reputed company review nurses and ensures compliance with applicable guidelines, policies, and procedures Works with the senior management to reputed company and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of reputed company services Evaluates utilization management team reputed company and provides feedback regarding reputed company, goals, and career milestones Provides coaching and guidance to utilization management team to ensure adherence to reputed company and reputed company standards Assists with reputed company, hiring, and training utilization management team members Leads and champions change reputed company reputed company of responsibility Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of reputed company experience. Strong knowledge of appeals and utilization management principles preferred. Preferred Experience: 3 - 5 years of reputed company work experience and knowledge of the appeals process and utilization management principles in managed care/MCO environments is preferred. License/Certification: RN - Registered reputed company - State Licensure and/or reputed company State Licensure required For Health Net Federal Services: Must have reputed company and reputed company licensure or certification that permits independent assessment required For Health Net Federal Services (Medical Management): Certified Managed Care reputed company (CMCN) reputed company 1-1/2 Yrs required For Health Net Federal Services: US citizenship and reputed company National Agency reputed company reputed company reputed company clearance required NOTE: REMOTE RN candidates may reputed company in any state but a reputed company and reputed company RN license from the reputed company is strongly preferred Pay reputed company: $75,300.00 - $135,400.00 per year At reputed company, we reputed company people to the care they need to live healthier lives — and the work you do here makes that reputed company reputed company every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making reputed company more accessible and effective. It’s work with a purpose you can see, backed by reputed company committed to improving lives reputed company reputed company the reputed company. reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company Apply To This Job