Remote RN: Benefit & Prior Auth Supervisor

CareOregon, Inc.; Oregon; Hybrid; USD 127,000 - 155,000; Full time

Benefits offered by this job

Bonus opportunity

Total rewards program

Remote work

Job summary

CareOregon, Inc. seeks an RN Clinical Benefit Management Supervisor to lead a remote team of RNs focused on Prior Authorization and Benefit Review.

The role ensures compliance with Oregon Health Plan rules, Medicare and DMAP/CMS regulations while guiding policy implementation and staff development. Key duties include supervising staff, improving processes, and coordinating with CareOregon departments to achieve program goals.

Qualifications

• Current unrestricted Oregon Registered Nurse's license.
• Minimum 1 year utilization management or prior authorization RN experience.
• 2 years' utilization management or prior authorization RN experience.
• Experience with the Oregon Health Plan (OHP) benefit, DMAP and CMS rules and regulations.

Responsibilities

• Supervise team and set direction aligned with mission and values.
• Identify staffing needs and recruit/hire with equity in mind.
• Ensure authorizations follow coverage rules and regulations.
• Provide on-going training and develop unit materials.
• Collaborate with other departments to support program goals.

Skills

Leadership

Communication

Problem solving

Multitasking

Team supervision

Education

RN license

Tools

QNXT

SharePoint

Job description

CareOregon, Inc. seeks an RN Clinical Benefit Management Supervisor to lead a remote team of RNs focused on Prior Authorization and Benefit Review.

The role ensures compliance with Oregon Health Plan rules, Medicare and DMAP/CMS regulations while guiding policy implementation and staff development. Key duties include supervising staff, improving processes, and coordinating with CareOregon departments to achieve program goals.