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