RN Team Lead — Utilization Management & Compliance

Inland Empire Health Plan; Rancho Cucamonga (CA); Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Competitive salary

State of the art fitness center on-<br

Medical Insurance with Dental and Vis

Life, short-term, and long-term disa

Career advancement opportunities and <

Wellness programs that promote a <

Flexible Spending Account – HealthCare

CalPERS retirement

457(b) option with a contribution m

Paid life insurance for employees

Pet care insurance

Job summary

Inland Empire Health Plan (IEHP) in Rancho Cucamonga is seeking a Team Lead - UM Regulatory & Compliance, RN to serve as the subject matter expert on prior authorization and letter reviews. You will be the first-line resource for clinical staff to ensure adherence to UM regulatory standards and LEAN initiatives.

You will collaborate with UM leadership to manage daily operations of clinical staff, oversee inventory, and help the QA team bridge gaps to maintain Plan standards.

Qualifications

• RN license in good standing is required.
• Three years minimum in clinical utilization management.
• Experience in an HMO or Managed Care setting preferred.
• Two or more years of direct clinical patient care in an acute facility.

Responsibilities

• Serve as SME on prior authorization and letter reviews.
• First-line resource for clinical staff to meet UM/regulatory standards.
• Collaborate with UM leadership to manage daily operations and staffing.
• Oversee inventory management and LEAN project alignment.
• Bridge gaps with QA and supervisors to ensure compliance.

Education

Associate’s degree in nursing

Bachelor’s degree in nursing

Job description

Inland Empire Health Plan (IEHP) in Rancho Cucamonga is seeking a Team Lead - UM Regulatory & Compliance, RN to serve as the subject matter expert on prior authorization and letter reviews. You will be the first-line resource for clinical staff to ensure adherence to UM regulatory standards and LEAN initiatives.

You will collaborate with UM leadership to manage daily operations of clinical staff, oversee inventory, and help the QA team bridge gaps to maintain Plan standards.