RN Utilization Management Supervisor (Remote)

Dignity Health Medical Foundation; United States; Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Equipment provided for remote work

Hybrid work arrangement

Job summary

Dignity Health Medical Foundation seeks a Supervisor of Utilization Management to oversee the UM Pre-Authorization team for Mercy Medical Group and Woodland Clinic Medical Group. The role emphasizes clinical and financial care, ensuring timely, compliant referrals and effective program implementation.

This position is primarily work-from-home within driving distance of Sacramento, CA, with occasional onsite meetings.

Qualifications

• Five (5) years clinical experience.
• Three (3) years Utilization experience in health plan/UM operations, acute or subacute utilization review.
• Bachelor's degree, or equivalent experience.
• Clear and current CA Registered Nurse (RN) license.
• Ability to demonstrate leadership and management skills.
• Knowledge of all applicable federal and state regulations as well as accreditation standards.
• Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements.
• Must have the ability to monitor, compile, report and analyze data/statistics.
• Requires excellent human relations, interpersonal and oral/written communication skills.

Responsibilities

• Coordinate daily UM Pre-Authorization operations and ensure timely processing of referral reviews.
• Apply clinical acumen and policies to Managed Care prior authorization requests.
• Foster collaboration between Pre-Authorization team, Medical Director, and Physician Reviewers.
• Organize and chair at least one pre-authorization meeting per month.
• Motivate and coach staff, including onboarding and problem solving.
• Provide information to UM Physicians for accurate referral reviews and monitoring of outcomes.

Skills

Leadership

Communication

Analytical skills

Regulatory knowledge

Customer focus

Education

Bachelor's degree

Job description

Dignity Health Medical Foundation seeks a Supervisor of Utilization Management to oversee the UM Pre-Authorization team for Mercy Medical Group and Woodland Clinic Medical Group. The role emphasizes clinical and financial care, ensuring timely, compliant referrals and effective program implementation.

This position is primarily work-from-home within driving distance of Sacramento, CA, with occasional onsite meetings.